2010 Grant Application - Canine Services
DR. HILDEGARD H. BALIN CHARITABLE TRUST
C/o Catherine N. Horton, Chairman of the Advisory Committee
P.O. Box 90960, Santa Barbara, CA 93190-0960
(805) 730-1905
Name of Organization:
Address:
Contact Person:
Telephone:
Email:
Founding Date of Organization:
Amount Requested from Balin Trust
(a specified dollar amount):

Date of Application:
Major sources of support for your group (name and percentage of support):
Purpose of Canine Program:
Type of request:
 Capital     Operating Support     Special Project
Description of project for which funds are requested:
How will these grant funds be used? Please describe, as applicable, the number of surgeries, dental services, vaccinations, adoptions, food provided, etc. Please be specific.:
Anticipated project period:

 Special Project     Ongoing Project     Multi-Stage (more than one year)
If this request is part of a multi-stage project, define the stages and time periods:
Unduplicated number of S.B. County dogs to be served by the project per year:

How frequently will the project be used?

Total project cost:
Amount requested from the Balin Trust as a percentage of the total project cost:
Other sources of funding support applied for (sources and amount for this project):
Secured commitments of funding pledges:
How do you use volunteers versus paid staff in your project?
How will this project be financed in the future (Will it be self-supporting? If not, what will be the source of support)?
What will this project accomplish?
Is this your first grant request to the Balin Trust?
 Yes     No
If no, list last grant award received (year and amount):
Do you anticipate further requests from the Balin Trust?
 Yes     No

Additional Instructions:
  1. Submit EIGHT copies of the grant application. Attach EIGHT copies of your specific Project Budget & EIGHT copies of your Accounting of Funds Spent, if your organization received funding last year. Three-hole punch all copies. DO NOT use staples.
  2. Submit ONE copy of your organization’s current overall budget.
  3. Submit ONE copy of Federal Tax-Exempt 501(c) (3) letter.
  4. Submit ONE copy of Mission Statement.