Grant Request For Funds Form

Date*

Name of person submitting this form*

First Last

Email of person submitting this form*

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Name of Parkold

Name of Park*

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Park Jurisdiction

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City of Atlanta Parks

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DeKalb County Parks

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City of Brookhaven

Total amount of previously submitted matching funds

Required if you received a Small Change or Park Pride matching grant. If you are not sure of this amount, please refer to your last submitted request for funds form or email grants@parkpride.org.

Amount of additional matching funds being submitted with this request

Required if you received a Small Change or Park Pride matching grant. Please enter the amount of matching funds being submitted for this request (above field).

Total matching funds to-date

Required if you received a Small Change or Park Pride matching grant. This will field will auto-calculate the sum of what you entered for previously submitted matching funds and funds being submitted today.

Documentation of Matching Funds - File #1

Max. file size: 50 MB.

Required if you received a Small Change or Park Pride matching grant. Please upload voided checks, paid invoices, or other documentation of matching funds being spent. You must have spent matching funds that equal or exceed your request from Park Pride. You do not have to upload documentation for matching funds submitted on previous requests.

Documentation of Matching Funds - File #2

Max. file size: 50 MB.

Required if you received a Small Change or Park Pride matching grant. Please upload voided checks, paid invoices, or other documentation of matching funds being spent. You must have spent matching funds that equal or exceed your request from Park Pride. You do not have to upload documentation for matching funds submitted on previous requests.

Documentation of Matching Funds - File #3

Max. file size: 50 MB.

Required if you received a Small Change or Park Pride matching grant. Please upload voided checks, paid invoices, or other documentation of matching funds being spent. You must have spent matching funds that equal or exceed your request from Park Pride. You do not have to upload documentation for matching funds submitted on previous requests.

Do you have additional documentation for matching funds?

Yes
No

Additional Documentation of matching funds for this request

Drop files here or

Max. file size: 50 MB.

Required if you received a Small Change or Park Pride matching grant. Please upload voided checks, paid invoices, or other documentation of matching funds being spent. You must have spent matching funds that equal or exceed your request from Park Pride. You do not have to upload documentation for matching funds submitted on previous requests.

Total amount of previously submitted grant expenditures*

If you are not sure of this amount, please refer to your last submitted request for funds form or email grants@parkpride.org.

Amount of grant funds being requested*

Total grant expenditures requested to-date*

This will field will auto-calculate the sum of what you entered for previously submitted grant expenditures and expenditures being submitted today.

Expenses to be reimbursed/paid*

Date	Vendor	Description	Amount

Please upload a receipt or invoice for each expense listed above.

Receipt #1 - Receipts/invoices for current payment request*

Max. file size: 50 MB.

Receipt #2 - Receipts/invoices for current payment request

Max. file size: 50 MB.

Receipt #3 - Receipts/invoices for current payment request

Max. file size: 50 MB.

Do you have additional receipts?

Yes
No

Additional Receipts/invoices for current payment request

Drop files here or

Max. file size: 50 MB.

Please upload a receipt or invoice for the rest of the expenses listed above.

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Receipts/invoices for current payment requestold

Max. file size: 50 MB.

Please upload a receipt or invoice for each expense listed above.

Payee Name*

Park Pride can either reimburse a member of your Friends Group for expenses or pay a vendor directly.

Payee Phone Number*

Is this a reimbursement?

Yes

A reimbursement does not require a W-9 or Certificate of Insurance (COI).

Does this payment require Park Pride to have a W-9 for the payee on file?*

Is the payee a contractor, freelancer, or consultant being paid more than $600? Did they provide goods for $5,000 or more? If so, Park Pride will need a W-9 from the payee. If we have their information on file, you can select 'no.'

Upload Payee W-9*

Max. file size: 50 MB.

Does this payment require Park Pride to have a Certificate of Insurance (COI) for the payee on file?*

Is the payee is a third party vendor or contractor conducting work in the park? If so, the payee must provide a certificate of insurance to protect Park Pride from liability for injuries or damages. If we have their information on file, you can select 'no.'

Upload Payee Certificate of Insurance*

Max. file size: 50 MB.

Preferred Method of Payment*

A member of your Friends Group or a vendor can be paid either via a mailed check or ACH direct deposit.

Does Park Pride have the payee's ACH authorization on file?*

To remit payment via ACH direct deposit, we must have an authorization form and voided check on file.

ACH authorization form*

Max. file size: 50 MB.

The ACH authorization fillable PDF form is linked here.

Voided check

Max. file size: 50 MB.

Please upload a voided check for ACH payment. If this in unavailable, we will call the vendor directly to confirm their information.

Address for check recipient*

Street Address Address Line 2 City State ZIP Code

Signature*

Email

This field is for validation purposes and should be left unchanged.

Grant Request for Funds Form