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2. Community Service Grant Funding Application Overview

   The Jurupa Valley City Council approved $55,000 to be utilized for approved mini-grant funding for projects benefitting the residents residing within Jurupa Valley.

4. Language Translation
   This form is available in English, Spanish, and over fifty (50) other languages. Use the Google Translate tool located on the bottom right of the screen to select your language preference.
6. Traducción de Idiomas
   Este formulario está disponible en inglés, español y en más de cincuenta (50) idiomas. Use la herramienta ‘Google Translate’ ubicada abajo a la derecha de la pantalla para seleccionar su idioma preferido.
8. Link to the Jurupa Valley Community Service Grant Funding Web Page
   View the Community Services Grants web page for information about the program and previous recipients.
12. Section 1: Project/Program Information
14. (1.1) Amount Requested*

    Amount should not exceed $5,000

16. (1.2) Project/Program Title*
18. (1.3) Start Date*
19. (1.4) End Date*
21. (1.5) If a Community Services Funding Grant is Awarded, Make Check Payable to:*
23. (1.6) Mailing Address*
27. Section 2: Organization and Geographic Area Served
29. (2.1) Name of Organization*
31. (2.2) Year Organization Founded*
33. (2.3) Website
35. (2.4) Number of Paid Staff*
37. (2.5) Number of Volunteers*
39. (2.6) Contact Name*
40. (2.7) Title/Position*
42. (2.8) Contact Person's Email Address*
44. (2.9) Telephone*
46. Geographic Area(s) the Organization Serves*
48. Geographic Area(s) the Project/Program Serves*

    Community Services Funding Grant must be exclusively used to serve Jurupa Valley.

50. Physical Address of Project/Program

    If different from Organization's Mailing Address. 

54. Section 3: Nonprofit Status
56. (3.1) Is this organization incorporated as a nonprofit?*
    -- Select One --YesNo

    If no, then ineligible to receive City funding.

58. (3.2) Date of Incorporation as a Nonprofit*
    (3.2) Date of Incorporation as a Nonprofit
60. (3.3) Federal Identification Number *
62. (3.4) State Identification Number *
64. Upload Verification from Federal (IRS) and State (FTB) as Follows:
66. (3.5a) IRS Deductibility Status*
67. Find Your IRS Deductibility Status Using This Link
    IRS Deductibility Status Link
69. (3.5b) State Entity Status Letter*
70. Find Your State Entity Status Letter Using This Link
    State Entity Status Letter Link
72. (3.5c) Most Recent IRS Form 990 or Upload Detailed Information about your Charity Found on the State Registry's Search Tool*
73. State Registry's Search Tool
    State Registry's Search Tool Link
75. Request for Taxpayer Identification Number and Certification

    W-9 Form

77. (3.6a) Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $250 including any business transactions, negotiations, investments, or interests in real property with a Jurupa Valley City Council Member during the past 12 months? *
    -- Select One --YesNo
79. (3.6b) If yes, please describe.
81. (3.7a) Is a Jurupa Valley City Council Member or Executive Staff Member a member of the Board of Directors or an Officer of the organization? *
    -- Select One --YesNo
83. (3.7b) If yes, please describe.
85. (3.8) This Application has been Authorized by the Organizations:*

    1. Executive Committee
    2. Board of Directors
    3. Members-at-Large

    Select all that Apply

89. Section 4: Mission Statement of Organization
91. (4.1) Briefly Describe the Goals and Objectives or Mission of your Organization*
95. Section 5: Grant Funding Project/Program Description

    Receipts/invoices will be required to be submitted to the City of Jurupa Valley to demonstrate that your organization used funding awarded by the City to support the project/program as described here. See the Compliance Report in section 8 of the application for details.

97. (5.1) Briefly Describe what the Project/Program is*
99. (5.2) The City of Jurupa Valley Grant Funding will be Used to Support:*
101. (5.3) Describe how your Organization will Spend the Grant Funding

     Include equipment or services that would be purchased and why.

103. (5.4) If Awarded, Explain how the Grant Funding will Specifically Benefit Jurupa Valley Residents*
105. (5.5) Estimated Number of People Expected to Benefit from this Project/Program*
107. (5.6) Estimated Number of Volunteers Involved in this Project/Program*
111. Section 7: Signature Page
113. (7.1) Authorization to Submit Application*

     • The information contained on this application is true, correct and up to date to the best of our knowledge. 
     • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. 
     • Every Community Service Funding application is considered individually and on its own merit. 
     • Awards will be given to organizations and activities that directly benefit the residents of Jurupa Valley. 
     • Funding is not immediately available to the recipient and requires an award letter signature upon approval. Please allow time for checks to be processed. 
     • The award of Community Service Funding does not constitute an automatic annual allocation. 
     • The recognition for Community Service Funding should accrue to the City of Jurupa Valley. 
     • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Jurupa Valley to ensure the funds were used appropriately. 
     • The recipient shall provide a full accounting with documentation on the use of awarded funds. 
     • The recipient shall return to the City any funds not spent or documented per the signed agreement. 
     • If awarded a Community Service Funding Grant by the City of Jurupa Valley last year, then compliance receipts must be submitted on or before this application’s due date or this application may be rejected as incomplete. 
     • If the application is approved, applicant agrees to comply with the Community Service Grant Policy and use the funds only for the purposes approved. All laws applicable to the City’s funding of the Grant will comply with any conditions added by the City Council. 
     • Applicant further agrees that the Community Services Grant Funding shall not be used for salaries; scholarships to students; payment of debts; or religious or political purposes. 
     • Applicant further agrees not to discriminate on the basis of sex, race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status, sexual orientation, citizenship, primary language, or immigration status or such other grounds as are established by law, in the expenditure of the Community Services Funds. 

     1. The applicant acknowledges and agrees to the above
115. Organization*
116. Date of Authorized Submittal*
     Date of Authorized Submittal

     Provide the date for the authorization/electronic signature.

118. Authorized Representative*

     Provide the full name of the person that is authorizing the submission of this form. This will serve as your electronic signature.

119. Title*
121. Name of Alternate

     If signed by other than designee or alternate, a resolution of the Non-Profit authorizing the person signing to approve the application is required.

123. For More Information, Please Contact:
     • Terri Rollings
     • trollings@jurupavalley.org
     • (951) 332-6464 Ext. 214
127. Section 8: Expenditure Report
129. Fiscal Year (FY) 2023-2024 Compliance Report

     If your organization is awarded a Community Service Grant in Fiscal Year 2023-2024 by the City of Jurupa Valley, all grant funds received must be expended anytime between September 1, 2023 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Jurupa Valley reserves the right to conduct an audit and/or require additional backup information to substantiate how funds received from the City were spent. 

     If the funds are not spent in accordance with the approved purpose stated on the application, the organization will be required to refund all unspent funds. To substantiate that Fiscal Year 2023- 2024 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices must be submitted to the City on or before the due date of: June 30, 2024.

Leave This Blank:


131. 1. Receive an email copy of this form.
132. Email address

     This field is not part of the form submission.

133. Submit

* indicates a required field