2017 Grant Request Form



Grant Request Form

The Kiawah Seabrook Exchange Club provides grants to local not-for-profit charities and schools that provide significant services to residents of Johns and Wadmalaw Islands.

The schools of Johns and Wadmalaw Islands and their students are eligible for approved school supported programs, monthly awards, and scholarships for post high school education.

The Kiawah Seabrook Exchange Club is seeking agencies and schools that address the following community needs:

  • Prevention of child abuse
  • Medical and health services
  • Hunger relief
  • Housing and shelter
  • Mentoring and empowerment of at risk youth and adults
  • Youth educational projects

If you wish to apply for a grant for your organization, please open, print and complete the attached PDF form below. Also, the Microsoft Word downloadable form available from the link below can be filled in directly  on your computer by typing in the requested information.  The Word document can be partially filled out and saved for later completion and the text boxes included will expand as more space is needed.  Below are the links to the PDF and Word  copies of the Grant Request Form.

PDF Version Link   [Grant-Request-Form-PDF-2017-1]

The above link will open the PDF Grant Request form in another window. The form can then be printed directly from this browser window and is intended to be used as a hard copy form for recording your grant request.  To return to the Exchange Club website, use the previous page button/arrow on your system.

Fillable Word Link  [Grant-Request-Form-Fillable-Word V2]

The above fillable Word link will download the blank form to wherever your system stores downloads.  Once the form is downloaded, it can be updated and saved in one or many sessions.  Simple save the file where you can find it again and later reopen it and continue filling in the requested information.

The form below is included here for your preview before obtaining the PDF or Word document and filling in the requested information:

Organization Name:  _____________________________________________________________

Mailing Address: ________________________________________________________________

City: _____________________________________ State: ________ Zip Code: ______________

Primary Contact: __________________________________ Phone No. ______________________

email address of Primary Contact: ___________________________

Exchange Club Sponsor:__________________________________


Applicant Information

Amount requested: ______________________

Date of Request: ________________________

Grant Request Project or Program Summary:



Organization Background

Please provide a brief history of your organization and its mission statement where applicable.




Has your organization received a grant from the Exchange Club in the past?

Yes ______ No ______


If yes, what specifically was achieved with this grant?




Is this organization a 501(c)3?                                           Yes ____ No _____
If yes, include the cover sheet only of the most recent IRS 990 filing. Please scan the page and attach for email submissions.

If your organization is not a 501(c)3, provide evidence of your current not for profit status. Omission of this evidence will eliminate your request from consideration. Public schools are exempt from this requirement.

How many are on your board of directors or mgmt committee? _______

Are any members of the Kiawah Seabrook Exchange Club involved in your organization?

Yes ____ No ____   If yes, who? ____________________________

How often does your board meet and what is the average attendance?


What is your service area and the population served?

Please provide a copy of your current financials and any additional financial information that will assist the evaluation of your funding request.

Program Specifics and Outcome Measurement

A complete program narrative. Include a summary of the impact of this program including expected attendance, enrollment or number of people served.

What are your measurable outcomes and how will you measure the success of your program?

Explain how your organization will accomplish your stated objectives. Be as specific as possible.

When will the activity begin and when will it be completed?

Include a statement regarding how the goals of the request would be modified if the full amount of requested grant is not provided.

Please provide any additional documentation in support of this grant request that will help the committee evaluate your request for funding.

Submittal information

The completed Grant Request Form should be submitted by:

via email:

  •  Exchange Club President
    Bob Leggett <rmlegg8@gmail.com>

(Supporting dicumentation can be scanned and attached or submitted by US Mail)


Or, US Mail

  • Box PMB-J, 130 Gardeners Circle
  • John’s Island, SC 29455


Applications may be submitted through August 15, 2017. Late applications will not be considered. The omission of documentation will eliminate an agency from consideration. Recipients of funds from the Exchange Club in the past are not guaranteed funding in the future.