Funding Request Form

Instructions: Please fill out this form completely and click "submit."

Applicants for expense funding MUST fill out, sign, notarize and mail to the office of Council Member Garodnick the Organization Qualification Form Packet. Applicants must also include a copy of their Char500 or complete a Charity Exemption form (included in the packet). An application is not complete without these forms and must be received by Friday, March 12, 2010. Capital funds through the office of Council Member Garodnick will also need to be received by March 12, 2010.

If your organization is applying for more than $10,000 in expense funds and funding for that agency has not been specifically preapproved by the agency through which you hope to receive the funding, you must also fill out the pre-qualification form at http://www.nyc.gov/html/dycd/html/resources/pql_discretionary_contracts.shtml. If your organization is applying for expense funds in any amount to be administered by the Department of Cultural Affairs, there is an additional form you must fill out available at http://www.nyc.gov/html/dcla/html/funding/program_application.shtml.

For more details and deadlines on the budget process, click here.

This year, the Administration and Council have streamlined the process for non-city capital (i.e. non-profit groups in non-City owned buildings) requests. The form must be submitted online at http://www.nyc.gov/html/nccr/. If your organization is applying for capital funds to be administered by the Department of Cultural Affairs, there is an additional form you must fill out available at http://www.nyc.gov/html/dcla/html/funding/capital_funding_request.shtml.

All requests to Council Member Garodnick's office must be received by Friday, March 12, 2010. Requests must be submitted online using the form below. Hard copies of Organization Qualification Form Packet should be mailed to

Council Member Dan Garodnick
250 Broadway, Room 1880
New York, NY 10007

If you have questions please feel free to contact Joanna Levin in the Office of Council Member Garodnick by calling 212-788-7393, or by emailing jlevin@council.nyc.gov.

* Required field.

Your Organization

Legal Name of Organization*

Your organization's Federal Identification (FEIN) Number*

Is your organization a 501(c) Corporation?*

Yes
No

Organization Contact Information (No P.O. Boxes)*

Building #*

Street*

Suite (if applicable)

City*

State*

Zip Code*

Contact First Name*

Contact Last Name*

Contact Prefix*

Contact Title*

Contact Phone #, with extension (if applicable)*

Contact Fax #*

Contact E-Mail*

Fiscal Conduit Information (FC)

What organization serves as your Fiscal Conduit?

What is its Federal Identification (FEIN) Number?

Fiscal Conduit Contact Information

Building #

Street

Suite (if applicable)

City

State

Zip Code

FC Contact First Name

FC Contact Last Name

FC Contact Prefix

FC Contact Title

FC Contact Phone #, with extension (if applicable)

FC Contact Fax #

FC Contact E-Mail

About Your Organization

Mission Statement*

Please state in no more than five sentences.

Annual Budget*

In which council district is your organization located?*

Does your organization serve residents of other districts?*

Yes
No

IF YES, which districts?

About Your Funding Request(s):

Note, there is a difference between a request for capital and expense funds.

Expense funds are an organization's operational funds for programmatic activities.

Capital funds are for hardware, such as computers and other equipment, and must be a request of more than $35,000.

Expense funds request:*

Total expense project cost (if applicable)

Purpose of expense funding requested*

Please state in no more than five sentences.

If you are applying for youth programming, please indicate whether your programs occur before or after school.

Before 3:00
After 3:00

Capital funds request

Total capital project cost

Purpose of capital funding requested

Please state in no more than five sentences.

Did your organization receive funding from the City of New York in previous years?*

Yes
No

IF YES: How much? (Please list amount for each year funding was received.)

IF YES: How were those funds used?