APPLICATION

click here for: APPLICATION for Requests of $5,000 or less

The van Löben Sels/RembeRock Foundation accepts grant applications on a continuous basis. The applications must be consistent with the mission and guidelines of the Foundation.  Please follow the format below. 

1. Organization information:

   1. Name of organization: _____________________________
      Address: ________________________________________
      Phone #: _________________
      Website: ____________________________

   2. Executive Director: _______________________

   3. Contact Person: _____________________

   4. Email and phone of contact person: ________________ / _____________

2. Amount requested and for what purpose (one or two sentences).
    

3. What is the current year organizational budget?  $ ____________
    

4. What is the current year project budget (if applicable)?  $ ____________
    

5. Provide a general description of your organization (who you are and what you do) not to exceed one page.
    

6. Describe the grant request in detail and what you hope to accomplish, not to exceed three pages.
    

7. List the organizations with which you collaborate on this project and describe the nature of the collaboration.
    

8. List grants received from the van Löben Sels/RembeRock Foundation over the past five years, including amount and purpose.

Fiscal and Budget Information:  

1. Submit an organizational budget, itemizing Revenues and Expenses, for the current year and the past year.  Under Revenues, list each foundation grant, government contract or corporate gift by amount and purpose.  
    

2. Submit an itemized project budget (if applicable) for the current year and the past year.  If this is a start-up project, please submit a start-up budget and a projected full year budget.  Under Revenues, list each foundation grant, government contract or corporate gift by amount and purpose.  Denote whether committed, anticipated, or pending.

Required Attachments:  

1. Documentation of tax exempt status.

2. Current roster of Board of Directors and a brief statement as to what each member brings to the organization.

3. Organizational chart, if applicable.

4. A copy of the last annual report, if available.

5. For a renewal grant, submit a year-end report (not to exceed two pages) on the previous grant. 

Miscellaneous:  

1. Proposal should be printed in readable size font (at least 12 pt.)

2. No 2-sided printed/copied pages.

3. No videotapes, audiotapes, CDs, unless requested.

4. No certified mail delivery.

5. If using Federal Express or other overnight courier, send “no signature required.”

6. Submit proposal (one unbound copy) signed by the Executive Director to:

Ms. Toni Rembe, President
van Löben Sels/RembeRock Foundation
131 Steuart Street, 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, Executive Director, at (415) 512-0572 or Gail Shuster, Program Administrator, at (415) 512-0500.

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