Organization

Funding Plan

Budget

Certify & Submit

Step 1 of 4

Organization Profile

Tell us about your organization. We fund workforce development, anti-trafficking, vulnerable community support, international relief, and faith-based ministry initiatives.

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Eligibility: Your organization must hold active IRS 501(c)(3) status and must not be excluded from receiving federal funds (verified via SAM.gov).

Legal Registration

Legal Organization Name *

DBA if different

EIN / Tax ID *

Format: XX-XXXXXXX

IRS 501(c)(3) Status *

Year Founded

SAM.gov UEI *

Required for all federal sub-grants. Register at SAM.gov.

SAM.gov Exclusion Status *

Confirm not suspended, debarred, or excluded

Contact Information

Executive Director / CEO *

Grants Contact *

Email *

Phone

Address *

Website

Annual Operating Budget ($) *

Mission & Focus

Mission Statement *

Primary Program Area *

Geographic Service Area

Population Served

Step 2 of 4

Funding Plan

Describe how funds will be used, outcomes you'll deliver, and your financial health.

Grant Request

Amount Requested ($) *

Period Start *

Period End *

Grant Type

First Grant from Vena Foundation?

Federal Award Purpose Statement * Required by FFATA — USASpending.gov

Measurable Outcomes & Performance Metrics *

Financial Health

Total Revenue — Last FY ($)

Fiscal Year End

Financial Statements *

Single Audit Status §200.501

Prior Federal Experience & Audit Notes

Indirect Cost Rate 2 CFR §200.414

Other Funding Sources

Other Funders for This Program

Vena Grant as % of Total Program

Prior Federal Funding

Step 3 of 4

Budget Breakdown

Provide a line-item budget for all requested funds. Every dollar must be accounted for.

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Allowable Costs Only (2 CFR §200.403): Federal funds may not be used for entertainment, lobbying, fundraising, fines, or contributions to other organizations.

Line-Item Budget

Description / ActivityCost CategoryAmount ($)

Amount Requested

Total Budgeted

Difference

% Accounted

Cost Allowability Certification — 2 CFR §200.403

Certify that all budgeted costs meet the following federal requirements:

Reasonable — Costs would not exceed what a prudent person would pay under similar circumstances.2 CFR §200.404

Allocable — All costs directly benefit this specific program and award.2 CFR §200.405

Consistently Treated — Costs treated the same as non-federal expenditures.2 CFR §200.403(c)

Documented — All costs will be supported by records accessible to auditors for 3+ years.2 CFR §200.334

No Unallowable Costs — No entertainment, lobbying, fundraising, fines, or penalties.2 CFR §200.421, §200.450

Step 4 of 4

Certify & Submit

Review your application and provide required certifications before submitting.

Required Certifications

Accuracy & Completeness — All information provided is accurate, complete, and truthful. Intentionally false statements may result in disqualification and legal consequences.False Claims Act (31 U.S.C. §3729)

Federal Compliance Agreement — If awarded, we agree to comply with all requirements of 2 CFR Part 200 and applicable federal statutes and regulations.2 CFR Part 200 · 2024 Revision

Audit Access Agreement — If awarded, we agree to permit Vena Foundation, the federal awarding agency, the Inspector General, and the GAO access to all records related to this award.2 CFR §200.332(b)(5) · §200.337

Non-Discrimination Certification — We do not discriminate on the basis of race, color, national origin, sex, disability, religion, age, sexual orientation, or gender identity.Title VI · Section 504

No Debarment or Suspension — Our organization and principal officers are not presently debarred, suspended, or excluded from federal participation.2 CFR Part 180 · Executive Order 12549

Authorized Signatory Name & Title *

Signature Date *

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Application Submitted

Your application has been received by Vena Foundation. Our team will review your submission and contact you within 10–15 business days.

Please save your reference number. You may need it for follow-up communications.