The Greater Kanawha Valley Foundation
TGKVF Funded Collaborative Partner Form
Partner Organization
Name:
Address:
☐ 501(c)(3)
☐Government Agency
☐Other
Federal Tax ID#
Phone:
Fax:
Website:
Executive Director or
CEO (please underline
one)
Contact Person
Name:
Title:
E-mail:
Phone:
Name:
Title:
E-mail:
Phone:
Organization’s Total Operating Budget :
Partner Requested
$
Grant Amount (TGKVF
% of Partner Requested Grant Amount for
Indirect Expenses:
does not pay 100% of any
project/program budget).
Proposed Use of Funds
Briefly describe your organization’s mission. (2-4 paragraphs-no more than 500 words)
Summary: Describe your role in and contributions to the overall grant request. (2-4 paragraphs-no more than 500 words)
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The Greater Kanawha Valley Foundation
TGKVF Funded Collaborative Partner Form
☒ By checking this box you agree to the following Board Resolution Requirements as well as certify that you have
read and agree with the terms of this grant application and that your organization’s Board of Directors has approved
the submission of this proposal. Please keep a copy of the Board Resolution for your files. Do not attach a copy to
this request.
 We have carefully read the information provided in the Grant Application Form. If we receive a grant, we agree to
use the funds specifically granted and spend the money within the time period allocated by the funder;
 We agree to participate in a coordinated evaluation process that will include program specific data from all grantees
that will show the collaborative impact of this grant on the identified TGKVF goal, objective(s) and indicator(s) of
success;
 We agree that the outcome and measurements of this grant will strengthen one or more forms of Community
Wealth;
 We will allow the funder to use the information provided in this request for public relations and will mention the
funder’s support in any publicity our organization generates regarding the project;
 We agree that future funding from TGKVF is conditional upon receipt and acceptance of any requested interim,
progress, or final reports; and
 We agree that the approved program and the terms and conditions of this agreement are subject to modification
only with the Foundation’s prior written approval.
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