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2. Thank you so much for your interest in this program.

   If you have questions about this application or need help with it, call or email Elaine Wang, City Manager: 802 655 6410 / ewang@winooskivt.gov

4. Name of your nonprofit organization*
6. Contact Name*
7. Contact Email Address*
8. Contact Phone Number*
10. Nonprofit Mailing Address*
12. City*
13. State*
14. Zip Code*
16. Which type of eligible organization is your nonprofit?*

    1. State registered unincorporated nonprofit association
    2. State registered nonprofit corporation
    3. Nonprofit corporation with 501(c)3 status with the United States Internal Revenue Service
    4. Organizations with a nonprofit fiscal sponsor that a state registered or has 501(c)3 status

    Note: If your organization is both a State registered nonprofit corporation AND a Nonprofit corporation registered with the United States Internal Revenue Service, only select 'Nonprofit corporation with 501(c)3 status with the United States Internal Revenue Service'

18. Please upload your notarized agreement between all members of the association
20. Please upload your Certificate of Incorporation
22. Please upload your IRS 501(c)3 determination letter
24. Please upload your letter from the fiscal sponsor stating the arrangement, or the executed agreement with the fiscal sponsor
26. Please upload your IRS 501(c)3 determination letter for the fiscal sponsor
28. What service(s) does the nonprofit provide? Check all that apply.*

    1. Food security
    2. Shelter
    3. Distribution of COVID related health information
    4. Other - describe below
30. If other, please describe
32. What is the total number of employees and/or volunteers at the nonprofit organization?*
33. How many years has the nonprofit organization served the residents of Winooski?*
35. Does your organization serve marginalized people who live in or frequent Winooski?*

    1. Yes
    2. No
37. If yes, please describe
39. Is your organization led by people from a historically marginalized community?

    1. Yes
    2. No
41. If yes, please describe
43. Amount of grant funding request (limit $10,000)*
45. Is the nonprofit interested in receiving funds if only a partial award is available?

    1. Yes
    2. No
47. Please describe how you will use the money. What are the intended outcomes? If you prefer to provide a verbal response to this question, simply type 'verbal' in the answer field. We will contact you within two business days to schedule a phone call, in-person meeting, or videoconference.*
49. Please describe the impacts COVID-19 has had on your nonprofit and those you serve:*
51. If the grant is awarded, do you intend to subgrant any or all of the funds?*

    1. Yes
    2. No
53. If yes, please describe why
55. Optional: Provide any other information you think is important for us to know, as related to your application.
57. Optional: If you have any other supporting documents you would like to include, please upload them here.
59. By checking 'Yes', I agree to release all of the above information to the City of Winooski COVID-19 Recovery Nonprofit Grant Evaluation Committee, City of Winooski Staff, and the Winooski City Council.*

    1. Yes
    2. No
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field