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Thank you for the meaningful work you do every day in our community. This application is for proceeds that will be generated by the sale of Cities 97 Sampler Volume 23, on sale November 17th, 2011 at metro Target stores. It is unknown at this point exactly how much money will be generated but our hopes are for between $500,000 and $720,000 as long as the Sampler sells out and production expenses stay as low as they have in the past.

To streamline the consideration process, we are only accepting applications online. The deadline to submit is October 7th, 2011. You must represent an eligible non-profit organization or charity that benefits and serves adults, children or animals in Minnesota/Western Wisconsin (KTCZ listening area).

The list of charitable 'causes' (not specific organizations) are submitted to Cities 97 listeners in an annual 'priority community need' survey emailed to more than 83,000 listeners and Sampler buyers in the Cities 97 Frequent Listener database. This serves as a guide to the charity committee’s decision process.

Sampler grants are a one-time event, so even if your organization has received a Sampler grant in the past, you MUST fill out the application each year as there is no guarantee of future grants. All eligible charities submitting will be considered. Charities selected for proceeds will be notified via email or phone on or before April 4th 2012. Proceed amount awarded to each charity will be communicated on or before May 14th 2012.

Thank you again for all the wonderful, heartfelt, and impactful work you do.

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Please read carefully and fill in all the required fields.
One submission per organization please.


*Organization Name:
*Address:
*City:
*State:
*Zip:
*Email:
*Tax ID/501c:
*Website:
*Year Founded:
*Mission Statement:
(60 Word Limit)
 
*Contact Name:
*Contact Phone:
*Contact Email:
 
*Have you received Cities Sampler proceeds in the past?:
    Yes No
If Yes, total received to date:
 
*For what specific program, event, need or goal within your overall organization would you use a Sampler grant?
(160 Word Limit)
 
*What dollar amount are you hoping to receive to meet your stated specific program, event, need, goal?
(choose one range)
$1,000 - $5,000
$6,000 - $10,000
$10,000 - $19,000
$20,000 - $25,000
$26,000 - $35,000
$36,000 - $45,000
$46,000 - $60,000
$61,000 - $80,000
$81,000 - $99,000
$100,000+
 
*Thinking of the specific program, need, goal you listed above, which cause category best fits or describes who you serve? (Please read each carefully and select one that best fits)
Children with Life Threatening Illnesses (resources for child and family in and out of hospital)
Food Shelves, Feeding Hungry
Domestic or Family Violence (spouse or child abuse)
Cancer Patient Support (financial, home upkeep, prepared meals, resources)
Homeless & Homeless Transition (housing/food/clothes/furniture/ emergency shelter)
Research for Adolescents With Disease (cancers and other diseases)
Active and Returning Military (family counseling, healing wounded)
Senior Assistance (meals, transportation, utility bills, home repair, sight and hearing resources)
Suicide Prevention (outreach for teens and young adults with depression, being bullied)
Senior / Adult Disease Research (Alzheimer's, Parkinson's, Cancer)
Research For All Cancers (Breast, Colon, Ovarian, Testicular, Blood, etc)
Domestic Animal Shelter Care and Protection (dogs, cats, and other pets)
Research For Physically Disabling Diseases (Multiple Sclerosis, Muscular Dystrophy, ALS)
Grief Counseling & Services (for loss of child or parent, coping parent of troubled or disabled child)
Youth Camps & Classes (for underprivileged, ill, disabled)
Environmental Causes (recycling, green programs)
Youth Mentorship
Youth Drug & Alcohol Rehabilitation
Physically Disabled Outreach (resources, jobs, activities, housing)
Well Baby (prenatal care, education for teen mothers)
Wildlife Protection / Medical Rehabilitation (raptors, abused exotic animals)
Autism (parent support/resources)
HIV / AIDS (support groups, socialization & education for kids)
Childhood Obesity
Other
 

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