Fillable 2020-2021-SRD-Grant - 2019-2020 SRD Grant Form

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2020-2021-SRD-Grant - 2019-2020 SRD Grant Form

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2/18/2020
Page 1 | 7
SRD Board Members
Melissa Allen
Diane Ballard
Megan Fox
Tony Hult
Jacob Ivanoff
Tom Keegan
Jay Nielson
Dossie Overfield
Alan Rosenbaum
Josh Spinney
Rick Stonehouse
Shoshone Recreation
District
1402 Heart Mountain Street
PO Box 1531
Cody WY 82414
307/527-3484
rickm@cityofcody.com
Rick Manchester
Director
Shoshone Recreation District (SRD) is Seeking Proposals for
Funding from Groups & Organizations within Park County
School District 6 Boundaries
Grant Form FY 2020-2021
Application Deadline Friday, March 20, 2020
Recreation oriented, non-profit organizations within the boundaries of Park
County School District 6 are invited to apply for funding. Grant applications
are due Friday, March 20, 2020 – 4:00 PM, email submissions are
acceptable. Grant money can be spent July 1, 2020 – June 30, 2021. SRD
funds items such as insurance, equipment, facility rental or use costs.
Salaries, contract labor, and scholarships are not eligible. SRD does not
reimburse; SRD must pay all vendors directly. An incomplete
application will not be considered.
The Shoshone Recreation District supports healthful and creative recreation
programs, facilities, and activities to enrich the lives of the residents of Park
County School District 6.
To be considered for a grant, please provide the following detailed
information relating to your request and organization:
1. Submit a completed application form with relevant attachments before
deadline. Applications are available on the City of Cody website:
http://www.cityofcody-wy.gov/175/Shoshone-Recreation-District .
Send, email or deliver to:
Mail: Shoshone Recreation District, PO Box 1531, Cody WY 82414
RickM@cityofcody.com
Call and confirm email submittals were received.
Or deliver to: Cody Recreation Center, 1402 Heart Mountain Street
Attention: Shoshone Recreation District
Questions:
307/527-3484 Rick Manchester
2. Applicants will be notified by mail, telephone or e-mail after the board
has reviewed all applications. At the discretion of the SRD Board,
group presentations and interviews may be required. If a presentation
is required, the organization will be contacted and presentations will be
scheduled on the evening of Monday, April 13 or Tuesday, April 14
(time & day TBD).
Note: You may supply additional information with this form as an
attachment.
Shoshone Recreation District Grant Form FY 2020-2021
(Please type or print legibly)
Name of Group/Organization Requesting Funding
Must reside within PC School District 6 boundaries
Is your organization incorporated as a non-profit organization under WY State Law and IRS
status?
_____Yes ______No
Type of non-profit organization--please explain:
Non-profit with IRS 501 (C) 3 STATUS
Federal Tax Identification Number:
Other (please indicate): ________
How long has your organization been in existence? Years
Is this your first year completing a SRD application for funding? _____Yes _____No
Is your organization within Park County School District 6 Boundaries? _____Yes _____No
Name & Title
E-Mail
Name & Title
Mailing Address
City/State/ZIP
Contact and Authorized Representative
Phone(s)
Secondary Contact and Representative
Phone(s)
12/19/201 9
Page 2 | 7
E-Mail
Grantamountbeingrequested:$
NameofProjectorProgram:______________________________________
12/19/201 9
Page 3 | 7
1. What is the primary purpose (recreation services) of your program, or project, and how does it
support the purpose of the SRD, which “supports healthful and creative recreation programs,
facilities, and activities to enrich the lives of the residents of Park County School District 6”.
2. Does your organization make scholarships available to participate in your program?
_____Yes _____No
If yes, explain.
3. Is your program open to participants with all skills and abilities?
_____Yes _____No
If no, explain.
4. Is there a selection or tryout process that limits the number of individuals involved that can
participate?
_____Yes _____No
If yes, explain.
12/19/201 9
Page 4 | 7
5. Why should this program or project be funded?
6. Is this a one-time request or will future funding be needed to continue this project?
7. Please explain your future plans for sustainability.
8. Describe other financial contributions, including in-kind, which have been or will be made
toward this project, if any. Will any of the funding requested be used for grant matching funds?
If yes, please provide list of grantor names, project description, grant amounts, and matching
requirements.
9. How many Park County School District 6 residents and non-residents are served in your
organization and how many people do you expect to participate in your program.
Estimated
Number of
PC School
District 6
Residents
Non-
Residents
Number of
Program
Days
Age
Groups
Served
Participant Registration
Fees Per Participant
2020
Projected
this year
2019
Last year
actuals
12/19/201 9
Page 5 | 7
10. Purpose of funding or how will the grant be used to enhance your program:
Total requested amount
by item listed in left column
Equipment, Materials & Supplies (please list) Equipment $
General Liability Insurance,
Directors & Officers Insurance
Insurance $
Field or facility fees (explain) Field or facility fees $
Other (explain) Other $
TOTAL above, grant amount being
requested
$__________________________
Is it feasible to purchase equipment/materials in Park
County School District 6?
_____Yes _____No
If no, explain.
12/19/201 9
Page 6 | 7
11. Budget Summary
Applicant Income
Source(s)
Committed or Requested
Funds
July 1 – June 30
1. Grants, Contributions:
$
Foundations,
Recreation District(s)
Please list funding use &
indicate requested or
approved.
2. Sponsors $
3. Other (specify): $
4. Earned Income:
Player & Entry Fees
$
Events, Fundraisers
5. In-Kind Support $
6. Applicant Reserve Funds $
TOTAL INCOME
$
Expenses
Applicants
Budget
July 1 – June 30
The totals below should
reflect the items shown on
pg. 5--Purpose of Funding
1. Salaries & Benefits $ Not eligible
2. Contracted Services $ Not eligible
3. Advertising & Printing $
4. Scholarships $ Not eligible
5. Repairs & Maintenance
(Vehicles, etc.)
$ $
6. Equipment, Materials &
Supplies
$
$
7. General Liability Insurance,
Directors & Officers
Insurance
$ $
8. Field or Facility Rent
$ $
9. Machinery/Equipment
$ $
10. Travel Costs
$ $
11. Dues & Fees
$ $
12. Other Expenses
(please describe)
$ $
TOTAL EXPENSES
$ $
SRD Funding Requested
$
12/19/201 9
Page 7 | 7
12. Authorization:
I certify that all of the information provided on this application is true and complete to the best of my
knowledge. Liability insurance coverage is also required for the organization identified on this
application. I understand that if asked by an authorized official of the Shoshone Recreation District, I
agree to give proof of the information that I have given on this application and to provide certificate of
liability insurance, coverage period and type of coverage. Your group/organization agrees to
indemnify the Shoshone Recreation District of any liability associated with the use of such funds and
certifies that this grant request has been approved by your governing board(s).
Individuals participating in recreational activities sponsored by the SRD agree to hereby operate in
accordance with the code of ethics: provide positive support, care, and encouragement for fellow
competitors and league officials. Treat other players, coaches, fans, and officials with respect;
demonstrate fair play and sportsmanship to all fellow competitors; understand that the officials are
there for the participants benefit and will agree not to direct any profane or threatening actions toward
them (either verbal or physical). The SRD will evaluate violations and may deny future funding.
Date:
Organization Requesting Funding:
Authorized Representative’s Signature:
Title:
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2020-2021-SRD-Grant - 2019-2020 SRD Grant Form

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Completed 11 July 2020

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