Grant Application

Organization Information
Application Organization*
Full Legal Name
Doing Business As
Previous Name
If Changed
Tax Exempt ID #
EIN
IRS Letter Date
Executive Director*
Attorney
If Applicable
Accountant
If Applicable
Contract Fundraiser
If Applicable
Fiscal Sponsor
If Applicable
Contact Information
Name*
Prefix First Middle Last
Title*
Email*
Phone Numbers*
Number Type (mobile, fax, etc.)
Website
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Organization Financial Information
Budgeted Expenses*
For current year
Endowment Size*
Market value as of fiscal year
Fiscal Year*
Major Funding Sources*
Organization Percentage
Organization Affiliation
United Way*
- Yes
- No
Other*
Chapter Type*
- National
- Regional
Request Data
Program / Project Title*
Total Budget
Request Amount*
Grant Duration*
Estimated Start Date*
Communities Served*

List the communities / counties served by this project / program
Program Reach*
Total number of people to be served during grant period
Youths with Disabilities Reach*
Total number of people under age 21 with documented physical or mental disabilities to be served during grant period
Brief Demographic Description*
Type of Request*
- Capital
- Technical assistance
- Operating
- Endowment
- Program / Project Start-up
- Other
Type of Request (Other)*
Please specify
Organizational Background
Brief summary of organization's history and statement of organization's mission*
Brief description of current programs / projects and activities*
Evidence of organization's overall effectiveness (please list achievement of specific organizational or program goals)*
Description of population and geographic region (community / counties) served by this organization*
Statement of Need or Community Benefit
What is the problem, challenge, or need that is unaddressed or unmet? Or what is the community benefit that this program or project will impart?*
What is the research, statistic(s), or evidence that shows this need or benefit exists?*
Program / Project Description & Methodology
IMPORTANT: Review the Foundation's funding guidelines / qualifications before responding to this section.

Grant Guidelines 2016-2017
Summary description of overall program / project to be funded under this grant*
Brief description of goals and objectives for this program / project*
Timetable for implementation and duration of program / project*
Evidence of use of best practices (For example, is this based on a program that has been shown to be effective in other settings? Is it based on national standards?). If the initiative is a pilot project and has not been done before, please list assumptions on why new approach will succeed.*
How and with whom will the organization collaborate on this particular program / project?*
Why is your organization positioned to address this need or benefit (eg. skills, location, etc.)?*
How is your project different from similar existing projects at other organizations?*
Evaluation and Results
IMPORTANT: Please see the glossary for definition of "Outcomes," as well as the funder's guidelines before completing this section.

Grant Guidelines 2016-2017

Grant Glossary 2015-16
Provide specific short-term, intermediate and / or long-term outcomes of this program / project and the timeframe within which they will occur.*
How will outcomes be measured and who (eg. staff, consultant, etc.) will measure them?*
How will the results be used and disseminated by your organization and / or others?*
How will the project's constituents and / or clients be actively involved in evaluating the project?*
If this is an ongoing program / project or it its purpose is to provide direct support to an ongoing program / project, summarize past quantitative and qualitative outcomes of that program / project.
Program / Project Funding Plans
List of other funders to whom this current proposal has been and will be submitted.
Funder Amount Requested Status (pending, declined, etc.)
Other anticipated funding for this current proposal including earned revenue, in-kind support, special events, fundraisers, etc.*
If this will be an ongoing program / project, describe plans and specific sources for future / long-term funding.
Required Financial Attachments
Total organizational budget for current fiscal year*
Accepted file types: pdf, doc, docx, xls, xlsx.
Including a column showing the organization's year-to-date status (budget vs. actual)
Project request budget*
Accepted file types: pdf, doc, docx, xls, xlsx.
For your entire project
Completed Form 990*
Accepted file types: pdf, doc, docx.
Most recent
Other Required Information
Board Members*
Name Organization
IRS Letter of Determination*
Accepted file types: pdf, doc, docx.
501(c)(3) organization
Organizational Chart
Accepted file types: pdf, doc, docx, jpg, png, gif.
If available
Letters of Commitment
Accepted file types: pdf, doc, docx.
If appropriate
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Organization Information

Contact Information

Organization Financial Information

Organization Affiliation

Request Data

Organizational Background

Statement of Need or Community Benefit

Program / Project Description & Methodology

Evaluation and Results

Program / Project Funding Plans

Required Financial Attachments

Other Required Information

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