Name of organization: ______________________________ 

Website: ______________________________ 

Address: ______________________________ 

City: ______________________________ 

Zip Code: ___________________

County: ______________________________ 

Executive Director: ______________________________ 

Phone #: ______________________________ 

Email: ______________________________ 

E.D. Signature: ___________________________________________ 

Contact Person: ______________________________ 

Phone #: ______________________________ 

Email: ______________________________ 

1. Description of the organization (who you are and what you do) not to exceed one page.

2. Amount requested: $_______________

3. Grants received from our foundation over the past 5 years, including the amount and purpose.

4. Purpose of the request: What are you hoping to accomplish? (not to exceed two pages)

Fiscal and Budget Information:

• Submit an organization budget and a project budget (if applicable) for the year to which this request pertains, including revenues and expenditures;

• Itemize on both the organization budget and the project budget all funding committed (c) or pending (p) from each foundation, corporation/business, and/or government agency (avoid acronyms);

• Itemize any significant change in either expenditures or revenues the organization has/is experiencing or anticipating, and list the reason for the change.

• If the request is for a start-up project, submit a first year start-up budget and a projected first full year budget.

Required Attachments:

• Documentation of tax exempt status;

• Current roster of Board of Directors and a statement as to their role on the Board (one sentence is suffice);

• For a renewal grant, attach a year-end report on the current state of the organization or the project to which the grant was requested. The report should state specifically how the grant was used. What was accomplished? (not to exceed two pages);

• A copy of the last annual report, if available;

• An organization chart, if applicable.

Allowed Attachments, but not required:

Reports, copies of articles, or newsletters that describe your organization and/or the project.

Miscellaneous:

• No cover letter please;

• Only one copy is requested/required

• Proposal should be printed in readable font (at least 12pt.);

• No 2-sided printed/copied pages;

• No staples;

• No delivery that requires a signature;

• No videos, audiotapes, CD’s unless requested.

Mail proposal to:

Toni Rembe, President
van Löben Sels/RembeRock Foundation
131 Steuart St., Suite 301
San Francisco, CA 94105

If you have any questions or need clarification on any of the items listed above, please call Dan Corsello, E.D., at (415) 512-0572 – direct line, or Gail Shuster, Program Administrator, at (415) 512-0500. Call for proposal submission deadline.