Grant Request Form

Identify the problem to be addressed and the needs to be met by the project. Provide supporting data.

Describe your program objectives, activities, strategies, staffing, partners, timelines and explain how the design will enable you to address the problem or need. Identify the project as a new or continuing program.

Specify your plans for financing the project at the termination of the grant. List other financing sources or strategies that you are developing.

Describe the proposed program or project outcomes, with reference to long-range plans of the organization. What outcomes do you want to produce by the end of the first year, second year, etc.? If your program is continuing, what intended outcomes have been achieved thus far?

Outline your plan to document progress and results. How will you measure expected outcomes and the effectiveness of your activities? What will be your criteria for success? What tools will you use to evaluate your program and organization (records, surveys, interviews, pre-and post-tests, community feedback, etc.)?

List of officers and directors, including occupations, places of employment, etc.

List of key staff members involved in the project.

Organization's current operating budget. Itemize all expenses and revenues.

If the requested amount is different from the total cost of the project or campaign, itemize all confirmed and anticipated sources of revenue, and provide a revenue total. Also, indicate the amount of funds, if any, for this project that will be drawn down from your operating budget and/or reserve fund or endowment.

Itemize your expenses and provide an expense total. Include any additional items relevant to your particular program, project or campaign.

This section should include:

- A list of assumptions on which the budget was based. - An explanation of any unusual budget items. - In-kind expenses and donations or matching funds should also be described. - If your organization has affiliates and/or subsidiaries, please explain.