Impact 100 Common Grant Application Sections

Transcription

1 Impact 100 Cmmn Grant Applicatin Sectins Fcus area designatin fr yur applicatin:* Organizatin Data Applicant Organizatin (Legal Name):* Ding Business As:* Previus Name, if changed: Address* Ohi Street Address Address Line 2 City State ZIP Cde List f Cunties served by the Organizatin: T chse multiple cunties, please hld "Cntrl" [Ctrl] r [Cmmand] and click additinal cunties with yur muse. Adams Bne Brwne Butler Campbell Clermnt Dearbrn If ther, please indicate which cunties utside thse listed abve will be served by the rganizatin: Website: Please enter a valid Website URL beginning with (e.g. Page 1

2 Phne:* Fax: IRS Name, as listed n 501(c)(3) letter:* IRS letter date: Tax Exempt ID number (EIN):* Executive Directr:* Executive Directr Phne: Executive Directr * Organizatin s Budgeted Expenses fr Current Year:* Endwment Size: Organizatin s Majr Funding Surces:* Page 2

3 Organizatin s Affiliatin and/r accreditatin bdy (check all that apply): United Way Better Business Bureau ArtsWave Chapter f Natinal r Reginal Organizatin (Specify) Other (Specify) Request Data Prgram/Prject Title:* Ttal Budget fr this Entire Prgram/Prject:* Amunt f This Grant Request t Impact 100:* $104, Prpsal Cntact Name:* Prpsal Cntact Title: Prpsal Cntact Phne: Prpsal Cntact Fax: Prpsal Cntact * Page 3

4 Cmmunity/Cunties served by this Prgram/Prject: T chse multiple cunties, please hld "Cntrl" [Ctrl] r [Cmmand] and click additinal cunties with yur muse. Adams Bne Brwne Butler Campbell Clermnt Dearbrn If ther, please indicate which cunties utside thse listed abve will be served by the prgram/prject: Brief demgraphic descriptin f ppulatin served by this Prgram/Prject:* 0 f 400 max characters Type f Request (check all that apply):* Capital Prgram/Prject Technical Assistance Start-up Save and Cntinue Later Page 4

5 Sectin Tw: Prfile f Organizatin The narratives fr sectins tw thrugh six typically d nt exceed five typed pages. Fr that reasn, character cunts have been incrprated int the text bxes fr these sectins. Brief summary f rganizatin s histry:* 0 f 800 max characters Brief statement f rganizatin s visin/missin:* 0 f 800 max characters Brief descriptin f current prgrams/prjects and activities:* 0 f 1500 max characters Descriptin f rganizatin s cnstituency and gegraphic regin (if different than the prject s as described abve):* Page 5

6 0 f 800 max characters Save and Cntinue Later Sectin Three: Statement f Need Statement f need prject is attempting t meet and evidence f that need:* 0 f 2000 max characters Save and Cntinue Later Sectin Fur: Prgram/Prject Descriptin & Methdlgy Descriptin f Prgram/Prject:* a. Activities t accmplish prgram/prject (Is this a new r an expansin f an nging activity? Clearly articulate hw this request deepens, bradens, r reimagines yur current peratins.) b. Gals/bjectives c. Timetable fr implementatin d. Duratin f prgram/prject e. Evidence f use f best practices (Is this prgram/prject based n a prgram that has been shwn t be effective in ther settings?) Page 6

7 0 f 6000 max characters Will the rganizatin cllabrate with ther rganizatins n this particular prgram/prject (if s, with whm and hw?):* 0 f 1000 max characters Why is yur rganizatin qualified t address this need:* 0 f 1250 max characters Save and Cntinue Later Sectin Five: Evaluatin Hw will the shrt term, intermediate and/r lng term utcmes be defined and measured? Hw will success be defined and measured?* Page 7

8 0 f 2000 max characters Hw will the evaluatin be cnducted?* 0 f 1000 max characters Hw will the peple served be invlved in the prgram/prject evaluatin?* 0 f 1000 max characters Hw will the results be used and disseminated?* 0 f 1000 max characters If this is an existing nging prgram/prject, please summarize past quantitative and qualitative utcmes: Page 8

9 0 f 1000 max characters Save and Cntinue Later Sectin Six: Prgram/Prject Funding Plans List f ther funders t which this current prpsal has been and will be submitted. Fr each funder, indicate amunt requested and status f request, i.e., request will be submitted, is pending, was funded r was declined. If funded, specify amunt f grant:* 0 f 1000 max characters Other anticipated funding fr this current prpsal including: a.) Earned revenue b.) In-kind supprt c.) Special events d.) Fundraisers, etc.* 0 f 1000 max characters If this will be an nging prgram/prject, describe plans and specific surces fr future/lng-term funding: Page 9

10 0 f 1000 max characters Save and Cntinue Later Sectin Seven: Required Financial Attachments Statement f Revenue/Supprt and Expenses fr yur rganizatin's mst recently cmpleted fiscal/calendar year and the previus tw years.* Dwnlad Statement f Revenue/Supprt & Expenses Example Balance Sheet fr mst recently cmpleted fiscal year and the previus tw years.* Mst recent audited financial statements cmplete with ntes and audit pinin as well as any ther pinin r reprt issued by the auditing firm fr the rganizatin.* If yur rganizatin des nt have an audit perfrmed, prvide ne f the fllwing fr each f the three mst recent years (in the rder preferred): a.) Independently reviewed r cmpiled financial statements, r, b.) Frm 990 Organizatinal Budget fr the current fiscal/calendar year including a clumn shwing the rganizatin s year-t-date status.* Dwnlad Current Fiscal Year Example Prject Budget fr yur entire prject.* Prject Budget fr the entire prject with Impact 100 prtin f the prject clearly dented. Please nte that the Impact 100 funding line items must ttal the exact amunt f the Impact 100 grant. Dwnlad Example: Prgram Request r Example: Capital Request Page 10

11 Prvide pr frma prject budgets fr the next three years if there are nging expenses assciated with yur prject which increase the rganizatin s perating budget by 20% r mre, r, if this is a new rganizatin. The purpse f the pr frma is t shw hw the rganizatin plans t sustain the prject. Save and Cntinue Later Sectin Eight: Required Nn-Financial Attachments Names, affiliatins and demgraphics f bard members:* This wuld include publicly available infrmatin fr yur bard f directrs. Bard members infrmatin file Use this bx if yu chse t uplad an rganizatinal chart. List f key staff members r an rganizatinal chart:* Key staff members r an rganizatinal chart file: Use this bx if yu chse t uplad an rganizatinal chart. Letters f cmmitment frm cllabrating rganizatins file (if apprpriate): Please scan all letters f cmmitment int ne pdf befre uplading. Page 11

12 Save and Cntinue Later Sectin Nine: Terms f Grant Agreement fr Impact Applicant agrees that any grant received frm Impact 100 will be expended fr the explicit purpses described in the grant prpsal. A frmal grant agreement will be cnstructed fllwing the Annual Awards Ceremny, utlining apprpriate uses and gals as initially prpsed in this request. In the event grant mnies are t be allcated fr any ther purpse, agreement must be btained frm Impact 100.* I agree 2. Applicant agrees if chsen as a Site Visit Candidate frm that time frward until the applicant is infrmed by Impact 100 that they are n lnger under cnsideratin fr a grant in that year, r, until the applicant cmpletes the prject utilizing Impact 100 funds t keep Impact 100 abreast f any substantial dnatin - in-kind r mnetary - that directly impacts the applicant's prpsed budget r prgram implementatin timeline submitted t Impact 100 thrugh this Cmmn Grant Applicatin. Mving frward within the Impact 100 grant review prcess shuld in n way prhibit yu frm btaining external supprt fr yur prpsed prgram and prject. In an effrt t be strng fiscal agents, sharing this infrmatin will ensure that Impact 100 authentically represents the applicant t membership and fcus area cmmittees.* I agree 3. Applicant agrees if chsen as a Finalist, t attend the Impact 100 s Finalist Annuncement in June and the Annual Awards Celebratin in September. In additin, if chsen as a recipient, t attend up t 2 member events a year t discuss yur prject/prgram and its prgress.* I agree 4. If a grant is received, applicant agrees t credit Impact 100 in the manner identified by Impact 100 in any publicatins (including annual reprts, newsletters), press releases, brchures, videtapes, and ther publicity r public relatins materials and presentatins.* I agree 5. Applicant agrees, fllwing expenditure f any grant received, t cmplete a biannual interim reprt and attend a meeting with the Impact 100 s Nnprfit Crdinatr at least annually fr the life f the grant. An itemized budget is part f this reprt.* I agree I, the undersigned, have read and understand the Terms f Grant Agreement, and, shuld we advance in the Impact 100 prcess, agree t fllw its terms and cnditins.* I hereby sign and agree t the abve-mentined terms By Executive Directr* Page 12

13 By Bard President* Submitted by* Submit Save and Cntinue Later Screen Yu Get If Yu Hit Save and Cntinue Later Text f Yu Get When Yu Hit Save and Cntinue Thank yu fr saving Cmmn Grant Applicatin. Please use the unique link belw t return t the frm frm any cmputer. Remember that the link will expire after 30 days s please return via the prvided link t cmplete yur frm submissin. Screen Cnfirmatin Once Yu Hit Submit Thank yu fr yur grant submissin t Impact 100. Yur applicatin has been received and will be reviewed by Impact 100 members in yur applicatin's designated Fcus Area. That review prcess will ccur frm early April thrugh late May Please see the fllwing imprtant cmmunicatin & planning dates. Yur cmplete applicatin has been ed t yu. Page 13 Wednesday, May 23, Nnprfits will be ntified via n later than this date if the rganizatin has been chsen as a site visit candidate. Middle June Nnprfits will be ntified if mving frward as a finalist. Finalists will be invited t review their "Executive Summary" utilized at the Annual Awards Celebratin.

14 Tuesday, June 26, 2018 (evening) - All finalists gather at "Meet the Finalists" event with Impact 100 members. Finalists will gather befre the event t review next steps. July-September - Finalists crdinate with Nnprfit Crdinatr n next steps and preparatin fr Annual Awards Celebratin. Thursday, September 13, 2018 (evening) - Finalists present at "Annual Awards Celebratin." Yu Will Receive an Cnfirming Yur Submissin Within 24 Hurs f Hitting Submit That Will Als Prvide a Cpy f Yur Applicatin Questins can be submitted t grants@impact100.rg Page 14