Application for Gaming Funds

Step 1 - Organization Details

Organization Name(Required)

Organization Primary Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Organization Phone(Required)

Date organization was established(Required)

Does your organization maintain offices or physical operations?(Required)

Yes

No

Additional Location Address(Required)

Use the "+" icon to add multiple entries.

Address

City

State

ZIP

Chief Executive Officer Name(Required)

First Middle Last

Chief Executive Officer Email(Required)

Primary Contact Person for this Application(Required)

First Middle Last

Primary Contact Person Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Contact Person Phone(Required)

Primary Contact Person Email(Required)

Board of Directors(Required)

Please list the names of each current board member and indicate if they are a Hammond Resident. Use the "+" icon to add multiple entries.

Name

Hammond Resident?

Does your organization have a paid staff?(Required)

Yes

No

Number of Employees(Required)

Does your organization maintain regular hours?(Required)

Yes

No

Hours of Operation

Use the "+" icon to add multiple entries.

Day of the Week

Hours

Is your organization incorporated?(Required)

Yes

No

Date of Incorporation(Required)

Tax Identification Number(Required)

Has your organization been granted 501(c)(3) status by the Internal Revenue Service?(Required)

Yes

No

Date 501(c)(3) Status Granted(Required)

501(c)(3) Proof(Required)

Please attach a copy of the letter of approval granting 501(c)(3) status.

Max. file size: 32 MB.

Has your organization applied for 501(c)(3) status?(Required)

Yes

No

Date 501(c)(3) status applied for(Required)

Is your organization affiliated with any other organization (such as serving as the local chapter of a national organization)?(Required)

Yes

No

Affiliated Organization Name(Required)

Affiliated Organization Address(Required)

Street Address Address Line 2 City State ZIP Code

Step 2 - Purpose/Mission of Organization

Please describe your organization’s overall purpose/mission.(Required)

Would you like to upload a prepared Mission Statement?(Required)

Yes

No

Please attach a prepared Mission Statement

Accepted file types: doc, docx, pdf, Max. file size: 32 MB.

Describe the primary services that your organization provides(Required)

How does your organization serve/benefit Hammond residents and taxpayers?(Required)

Step 3 - Funding Request

Amount Requested(Required)

Purpose/Use of Funding(Required)

Please describe in detail how these funds will be used if granted.

What is the overall cost of your project?(Required)

What percent of the project will this grant fund?(Required)

Describe in detail the funding stack for this project.(Required)

How will this grant benefit Hammond residents and taxpayers?(Required)

Does your request include operational expenses such as salaries/wages/overhead?(Required)

Yes

No

Please define the portions of the grant that would be allocated for salaries/wages/overhead.(Required)

Please describe the timeline for this program/use (When will it commence? When will it be completed?)(Required)

Did you receive funding from this commission last year?(Required)

Yes

No

Did you complete the projects from last years allocation?(Required)

Yes

No

Please provide details on last years grant award.(Required)

Project Photos

If available, please attach photos exhibiting the use of lasy years allocation.

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 32 MB.

Step 4 - Financial Status

Does your organization receive funding from other sources?(Required)

Yes

No

List sources your organization receives funding from(Required)

Use the "+" icon to add multiple entries.

Source

Amount (% of Annual Revenue)

Has your organization applied for other funding from the City of Hammond (including Community Development Block Grant (CDBG) funding)?(Required)

Yes

No

Please describe when the application was made, to whom, and how much funding was requested.(Required)

Use the "+" icon to add multiple entries.

Appication Date

Organization

Amount Requested

Please attach your organizations most recent annual financial report, audit, or tax return.(Required)

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 32 MB.