Get A Referral Online – State Bar of Nevada

Organization Name*

Primary Contact*

First

Last

Organization's Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Phone Number*

Organization Information

Please check all that apply:

The organization is a 501(c)(3) public charity
The organization is a 501(c)(3) private charity
The organization is a 501(c)(6) charitiable organization
The organization is not a 501(a)(3) supporting organization

Briefly describe your organization's mission and goals (250 words or less)*

Funding Request

Program Title

Total Amount Requested*

Will requested funding be used for a new program or existing program?*

New Program
Existing Program

Please indicate which initiative(s) supported by the IDEA grant the organization seeks funding.*

Pipeline program
Scholarship program
Wellbeing initiative that fosters improvement in the legal culture, promotes mentorship, or that aids in the building of a community of inclusivity.

What are the defined outcomes of the program for which the organization seeks funding as it relates to the initiative(s) above?*

Who will benefit from awarded funding?*

Please provide details of who will receive grant dollars and the geographic location of recipients.

Has the organization received funding for this program previously?*

Yes
No

Please provide detailed information related to how previous grant funding has been used and what dollars, if any, remain.*

What is the anticipated schedule for when funds will be expended?*

Does the organization receive funds from other sources to support the program identified in this grant application?*

Yes
No

Please describe the other sources of support (source and amount) and how any granted dollars will supplement these sources.*

If the organization seeks additional funding for the program outside of the State Bar of Nevada grant funding, please describe the organization's ability to raise matching funds.*

Will this program be able to continue after all SBN funds are expended? Please explain.*

This application represents what percentage of the organization's overall annual budget?*

Additional Information

Please upload the following documents to support the organization's grant application. Please submit each document as a PDF.

Current list of board members*

Max. file size: 100 MB.

Budget for the program or activity for which funding is sought.*

Max. file size: 100 MB.

Organizational budget, which includes a balance sheet.*

Max. file size: 100 MB.

Agreement for Use of Funds

The undersigned, on behalf of the organization, consents to:*

Select All
Utilize the funds granted to this organization solely for the purpose permitted and outlined in the application.
Agree to repay the State Bar of Nevada any amount not used for the purposes of this grant.
Release its application and subsequent reports as property of the State Bar of Nevada for use of any or all information presented, whether or not the application is accepted for funding.
Appropriate credit or recognition to the State Bar of Nevada in any printed or electronic materials and communications describing activities which are wholly or partially funded by grant funds.
Submit an annual report regarding the use of funds prior to the anniversary date of initial grant approval, or prior to application for additional grant funds, whichever comes first.

Signature

Date