BROOKSHIRE BROTHERS CHARITABLE FOUNDATION (“BBCF

BROOKSHIRE BROTHERS

CHARITABLE FOUNDATION

(“BBCF”)

APPLICATION FORM

FOR GRANT APPLICATIONS 2023

The Brookshire Brothers Charitable Foundation (“BBCF”), based out of Lufkin, Texas, is a non-profit, tax-exempt

organization operated for charitable purposes under the appropriate provisions of the Internal Revenue Code

and Regulations. BBCF seeks to enhance the quality of life in Texas and western Louisiana by supporting

organizations that directly and positively impact the people living and working in areas served by Brookshire

Brothers, Inc. Specifically BBCF supports organizations involved in the areas of education, health, community

and social services, cultural arts and the humanities. Applicants must be an organization exempt from federal

taxes under SECTION 501(c)(3) of the Internal Revenue Code.

Instructions for Grant Applications:

1. All grant requests must include a completed BBCF application form and all required attachments.

Applicants can email their grant requests to [email protected]

or mail their requests to the address below.

2. Applicants must include the following attachments to the completed application:

a. One-page cover letter that details the organization's purpose, a strategic reason for the why

the BBCF should consider funding the project and/or program, and the amount requested.

b. List of current members on the organization’s board of directors.

c. List of organization’s principal officers.

d. Copy of organization’s most recent annual audit with independent auditor’s report.

e. Signed W-9 dated within past 12 months.

f. Organizations that have received a previous BBCF grant must complete a final written grant

report, which can be found in this application.

g. Photo release form.

h. Photos from the past year demonstrating how the organization executes on its primary

objectives.

Failure to include all documents will void your application.

3. If you choose to mail your application, please send only one copy of the application with attachments.

Do not bind your documents in a notebook or other hard cover folder. Do not send pamphlets,

brochures, books, cassettes, videos or similar materials.

Mailed applications may be sent to:

Attn: Melissa Crager

Brookshire Brothers Charitable Foundation

P.O. Box 1688

Lufkin, Texas 75904

APPLICATIONS MUST BE SUBMITTED OR POSTMARKED BY NOVEMBER 1, 2022.

Someone from the BBCF will contact you after your application has been received.

For questions, please email [email protected] or [email protected].

APPLICATIONS MUST BE SUBMITTED OR POSTMARKED BY DECEMBER 4, 2020.

BROOKSHIRE BROTHERSBR

CHARITABLE FOUNDATION

(“BBCF”)

APPLICATION FORM

FOR GRANT APPLICATIONS 2023

Organization Name: ___________________________________________________________________________________________

(as shown on 501(c)(3) IRS Exemption Letter)

Street Address/P.O. Box: _______________________________________________________________________________________

City, State, Zip Code: __________________________________________________________________________________________

Primary Phone Number: ______________________________ Taxpayer I.D. #: _____________________________________

Contact Person and Title: ______________________________________________________________________________________

Contact Email: __________________________________________________________________________________________________

Organization’s website and/or social media accounts:

__________________________________________________________________________________________________________________

Year Founded: ____________________________

About Your Organization

What is your organization's primary purpose and/or mission?

_________________________________________________________________________________________________________________

Outline your current programs and activities:

___________________________________________________________________________________________________________________

Number of Paid Employees: ___________________________

Full-Time: _______________________________________________ Part-Time: ________________________________________

Number of Volunteers: ________________________________________

Which geographic areas do you serve? (List all counties/parishes) ___________________________________________

_________________________________________________________________________________________________________________

What is your target population and/or demographic?

_________________________________________________________________________________________________________________

How many people does your organization serve annually? _____________________________________________________

APPLICATIONS MUST BE SUBMITTED OR POSTMARKED BY NOVEMBER 1, 2022.

• Describe the proposed campaign, including goals and objectives.

__________________________________________________________________________________________________________________

• Define the campaign as new or ongoing and provide information on its status. Include a timetable for

implementation and completion.

________________________________________________________________________________________________________________

• Specify your plans for sustainability following the end of the grant.

________________________________________________________________________________________________________________

Project, Program or Operating Budget

• Describe your program objectives, activities, strategies, staffing, partners and timelines. Explain how the

grant will enable you to address the problem or need. Identify the project as new or ongoing.

_______________________________________________________________________________________________________________

• Specify your plans for sustainability following the end of the grant.

_______________________________________________________________________________________________________________

Other

• Please describe.

_______________________________________________________________________________________________________________

What objective criteria and outcome indicates success? How will you know if you have met the criteria?

________________________________________________________________________________________________________________

Grant Request

Amount requested: ____________________________________________________________________________________________

How many people would be affected by this grant?

_________________________________________________________________________________________________________________

Explain how your organization would use this grant:

________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Type of Request: Capital Operating Budget Other _________________________________________________

Capital

Other Funding

Has your organization received funding from the Brookshire Brothers Charitable Foundation in the past? ______

If yes, during which calendar year(s)? ____________________________________

If yes, what was the funding used for? ____________________________________________________________________________

List other sources of funding for your overall organization and explain how those funds have been used.

_____________________________________________________________________________________________________________________

List any additional community partners who are participating in this project/program and what are they

providing (i.e. funds, in-kind donations, etc.).

_____________________________________________________________________________________________________________________

How did you hear about the BBCF grant? __________________________________________________________________________

By checking this box, you agree that your organization’s name and possible photographs of employees/

volunteers may appear in press releases and on the Brookshire Brothers, Inc. and Brookshire Brothers

Charitable Foundation’s websites and social media sites.

Thank you for submitting your request. The Brookshire Brothers Charitable Foundation board meets in December

to review all submissions. You will be notified in January with the results.

2022 Final Report

1. Include a financial summary and detailed report describing the disbursement of

BBCF grant funds from the 2022 grant.

2. Include a written account of how your organization utilized the BBCF grant this past year.

The report should include information related to the following questions:

a. What expected and unexpected successes did the project/program encounter?

b. What expected and unexpected problems did the project/program encounter?

c. How many people were served by the project/program, and what was the impact

on them?

d. What are the lasting benefits of the project/program?

e. If the project/program were to be done again, would you do anything differently?

If so, what?

f. What are the specific plans for continuation of the project/program?

g. Were there other sources of funding used to support the project/program?

If so, please indicate the sources and amounts.

3. Include photo documentation of project/program and testimonials from clients.

Please send photos by email to [email protected].

For organizations that received a grant from the Brookshire Brothers Charitable

Foundation in 2022, please attach a separate document with the final grant report.

Photo Release Form

Brookshire Brothers, Inc.

1201 Ellen Trout Dr.

Lufkin, Texas 75904

Permission to Use Image/Photo

I authorize Brookshire Brothers, Inc. and the Brookshire Brothers Charitable Foundation, its

assigns and transferees to use and publish the photos/images in print and/or electronically.

I agree that Brookshire Brothers, Inc. and the Brookshire Brothers Charitable Foundation may

use such photographs with or without the names of those in the photo/image and for any lawful

purpose, including for example such purposes as publicity, illustration, advertising, and Web

content.

I have read and understand the above:

Signature _________________________________

Date _____________________________________

Printed name ______________________________

Address __________________________________