SAFE Charlotte Grants Application

For more information on the Safe Charlotte grant, and to access the required documents, view the Safe Charlotte FAQ page.

Lead agency name

Address Autocomplete

Address or Location

Director/CEO

Contact person

Phone Number

Annual operating budget amount (must be greater than $800k)

Partner agency 1 name

Address Autocomplete

Address or Location

Director/CEO

Contact person

Phone Number

Partner agency 2 name (if using)

Address Autocomplete

Address or Location

Director/CEO

Contact person

Phone Number

Overview of lead agency

Overview of partner agencies

3-5 sentence overview of the project/program

Proposed project population

Capacity building

Program Period

Issue 1

Goal

Outcome

Goal

Outcome

Goal

Outcome

Goal

Outcome

Goal

Outcome

Issue 2

Goal

Outcome

Goal

Outcome

Goal

Outcome

Goal

Outcome

Goal

Outcome

Before hitting submit, make the following check boxes.

I acknowledge the following

This is a reimbursement-based grant and payment for services will be based on timely and accurate submission of invoices.

I acknowledge the following

I am (or will) be registered with the System for Award Management (SAM.gov) throughout the period of this contract.

I acknowledge the following

My organization is prepared to meet the City of Charlotte’s insurance requirements during the full contract period.

Required Documents (all required)

Project budget for capacity building period

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Project budget for program period

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Organization budget for each organization

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501c3 verification letters for each organization

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Charitable solicitation license for each application

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Organizational chart for each org

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Lead applicant audit, to include audited statements associated with findings or concerns, if applicable

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Lead applicant 990

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