By Edna Harrison,2014-12-12 01:04
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    200 North Larchmont Boulevard, Ste. 3

    Los Angeles, California 90004



    The DJ & T Foundation awards two types of grants. They are (1) Spay/Neuter Clinic grants and (2) Spay/Neuter Assistance Program (SNAP) Grants. These grants are described below. Please indicate the type of grant for which you wish to apply by placing an “x” in the box next to the grant description.

    1. Clinic Grant: Granted to 501 (c) 3 organizations that operate low-cost or free

    spay/neuter clinics or are planning to open one. Funds are also granted to 501 (c) 3

    organizations that operate a low-cost or free mobile spay/neuter clinic or are

    planning to start one.

    2. Spay / Neuter Assistance Program (SNAP) Grant: Granted to 501 (c) 3

    organizations with established public outreach programs for companion dogs with

    homes or that are planning to establish such a program. Grantees that adopt out

    dogs, may not provide or use DJ & T SNAP Grant funds in any manner whatsoever

    to reduce, offset or supplement adoption fees, or to pay spay/neuter fees prior to or

    after adoption, or to supplement or pay for spay/neuter surgeries for dogs in foster,

    adoption, rescue or sanctuary programs. Grantees may not share a SNAP Grant in

    any other manner whatsoever with organizations or individuals involved in foster,

    adoption, rescue or sanctuary programs. DJ & T SNAP Grants are to be used only in

    public outreach programs, to provide spay/neuter surgeries for dogs belonging to

    individuals who require financial assistance. No exceptions.

After placing an “x” in the box beside the grant for which you wish to apply, please fully

    complete the remainder of this application. For your application to be considered, all

    information requested must be supplied. Please submit the application intact (do not separate the pages). Place all supporting materials behind the application.

    1. Name, Address and Telephone Number of Organization

_____________________________________________________________________________________ Name

_____________________________________________________________________________________ Address

_____________________________________________________________________________________ Telephone Number

    Web Application

    2. Year and State formally organized__________________________________________________________

    3. Name, Title and Telephone Number(s) of the person to contact regarding this application who can answer

    detailed questions about your organization’s spay/neuter program and daily activities for the DJ & T Foundation


    _____________________________________________________________________________________ Name, Address & Title

    __________________________________________ _________________________________________ Business Telephone Number Home Telephone Number ____________________________________________________ ___________________________________________________ E-Mail Address Cellular Telephone Number

    4. Amount of Grant Request $_______________________________________________________________

    5. Total endowment funds $_______________________as of (date)_________________________________

6. For the latest fiscal year:

    Total Contributions $__________________________

    Other Revenues $__________________________

    Total Expenses $__________________________

    7. Please list the donor and amount of the three largest contributions received by your organization during the latest

    fiscal year:

    Name____________________________________Amount $_____________________________________

     Name____________________________________Amount $_____________________________________

     Name____________________________________Amount $_____________________________________

Web Application

8. Please submit the following in support of application:

    A. A summary of how you propose to use the grant that your are requesting.

    B. Detailed budget for project. Include the percentage, if any, of administrative costs charged to this project.

    C. Description of qualifications of personnel assigned to project.

    D. Most recent fiscal year end tax return (990 Form) and audited financial statement or current unaudited

    financial statement.

    E. List of principal officers and directors of your organization.

    F. List the name, title and salary of the three highest paid persons affiliated with your organization.

    G. Copy of Internal Revenue Service determination that applicant is an exempt organization under section

    501 ( c ) 3 of the Internal Revenue Service Code. The name of the applying organization must be identical

    with that on the exemption letter.

9. The undersigned executive officers hereby certify that:

    A. The information set forth in this application and supporting documentation is correct.

    B. The Internal Revenue Service determination referred to in 8 (G) above has not been revoked, canceled or


    C. No funds received pursuant to this application will be used for activities prohibited by the 1969 Tax

    Reform Act, as amended.

    ______________________________________________ _______________________ Signature of Applicant (Must be Board Member or Executive Officer) Title

________________________ __________________ _______________________

    Name Home Telephone Number Date

    _____________________________________________ _______________________ Second Signature required (Must be Board Member or Executive Officer) Title

________________________ __________________ _______________________

    Name Home Telephone Number Date

Web Application

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