The Dana Brown Charitable Trust
Organization Synopsis
Name of Organization:
Amount of Request:
$
Brief Synopsis of Grant Request:
NOTE: Do not print smaller than 12-point type; Limited to 1,000 characters
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The Dana Brown Charitable Trust
Grant Application Form
Date:
Applicant:
(Name as it appears on IRS Determination Letter; add commonly used name, if different.)
Address:
Street
City
State
Zip
Contact Person:
Name
Email
Telephone
Signature of Board Officer
Signature of Chief Executive Officer
Print Name
Print Name
FAX
NOTE: Do not use print smaller than this 10-point type; No attachments allowed except for Section 3;
Each question limited to 2,000 characters.
1.
Amount requested from Foundation:
Indicate with check mark whether request is for:
Special program
Major capital expenditure
Operating support
State very briefly the specific purpose to be served by the requested grant:
2.
Brief description of your organization and its primary objectives:
Date established:
No. of paid employees:
No. of currently active volunteers:
3.
Include list of Board of Directors (attachments for this section only are permissible):
4.
List previous grant applications to the Trust during the past five years.
Date of
Application
Purpose
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Amount
Requested
Amount
Approved
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The Dana Brown Charitable Trust
Grant Application Form
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Applicant:
(Name as it appears on IRS Determination Letter; add commonly used name, if different.)
5.
Fully describe (to the extent of the allowed space) the general purposes, specific objectives and duration of the program
for which you are seeking funds.
6.
How was the need for this program determined and how will this program respond to the needs?
7.
Describe your organization’s special qualifications to address these objectives.
8.
List other groups addressing the same or related objectives and the extent of your coordination with each in developing
your proposal.
9.
What is the total amount needed for this program?
List other sources of support to which you are making application for this program:
Source
Amount Requested
Current Status
10.
If the project is successful, how will it be funded in the future?
11.
Describe the program’s evaluation plan. Please be specific about who will evaluate it; expected dates for assessment of
your objectives; criteria for judging success (such as dollars saved, problems solved, etc.)
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The Dana Brown Charitable Trust
Grant Application Form
Page 3
Applicant:
(Name as it appears on IRS Determination Letter; add commonly used name, if different.)
12.
General financial information:
Please provide the following financial information for your latest fiscal year and for your current budget.
(St. Louis chapters of national organizations should provide St. Louis information only.)
Latest Fiscal Year
Current
Annual Budget
Revenues
Fees, admissions and other earned income (other than government
contracts)
Government programs*
Interest and other investment income
United Way
Memberships and individual gifts
Foundation grants*
Corporate grants*
Other
Total
*List below the names and amounts of your five largest sources in the marked categories in the latest fiscal year. (top 5 overall)
Latest Fiscal Year
Current
Annual Budget
Expenditures
General and administration
Program
Fundraising
Property, plant and equipment
Other
Total
Please submit ten (10) copies of your cover letter on letterhead, the completed synopsis page, the completed and signed grant
application, board/officer list and IRS 501(c)(3) determination letter.
When completed, send to:
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Carol Eaves
The Dana Brown Charitable Trust
The Private Client Reserve of U.S. Bank
Mail Code: SL-MO-CTCS
10 North Hanley Road
Clayton, MO 63105
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The Dana Brown Charitable Trust
Instructions to Complete Grant Application Form
The Trust receives hundreds of grant requests each year. In order to give each request a fair and balanced
review, this grant application has been designed by the Grants Committee to give it the background information
it needs to make an informed decision. Applicants must complete the form exactly as directed or the request
will be rejected by the Trust staff before consideration by the Committee and returned.

Please complete the Organization Synopsis page. Please be brief and concise as spacing is limited to
1,000 characters.

Applications which are not signed by both the Senior Board Officer and the Executive Director will be
rejected and returned.

Applications with missing, incomplete or non-responsive answers to any of the twelve (12) required
sections will be rejected and returned.

Applications which call for the Committee to refer to attached materials in lieu of a response in the
spaces provided on the grant application will be rejected and returned (exception is Section 3, Board of
Directors).

Ten (10) copies of your cover letter on letterhead, the completed synopsis page, the completed and signed
grant application, board/officer list and 501(c)(3) determination are the only items that will be accepted.
All other information will be discarded.

The grant making committee meets on a quarterly basis and requires that the completed paperwork be in
our office no later than the 15th of February, May, August, or November. The meetings are held in the
month following these deadline dates.

Please Note: All organizations must take one full fiscal year off prior to reapplying to The Dana Brown
Charitable Trust, regardless of whether the organization has been approved or declined for funding. The
fiscal year of The Dana Brown Charitable Trust is July 1 to June 30.
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