Community Impact Grant Application

 

2019-2020 Community Impact Grant Application

 

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Be sure to log out when done working on the form. 

Only electronic versions of the application will be accepted. 

You will be required to download the following documents, complete them, and upload them into this application tool.

Financial Data & Proposed Budget
Fiscal Summary
Self-Certification Checklist
Signature Certification

Click here for Community Impact application guidelines.

 

PART I - Agency Information

Primary Contact's Information

CEO's Information

Part II - Program Information

Please provide an overall description of your organization. The description should include the following elements: • History, mission and goals • Main program/services your organization provides • Explain your organization’s qualifications to lead the program to be funded
Please describe who will be served by the proposed program. • Identify the impact area, focus issue and goal to be addressed. • Identify the population that will be served and demographic information including eligibility and selection criteria.
Please describe how your organization will use the requested grant funds. • Describe the research-based/evidence-based program, services or activity that will be provided. • Note any other organization providing the same or similar services and how duplication will be minimized.

Part III - Outcomes Data

Please describe the proposed program outcomes to be achieved. The description should include the following elements: • Address how participants’ circumstances will be improved. • Describe the method you will use to evaluate the outcomes. • Provide an explanation of how data will be collected and analyzed.
Financial Information
Please describe partnerships your program has with other organizations. • Identify shared goals and outcomes. • Describe the collaborative structure and division of responsibilities. • Identify how resources will be shared.
If so, what is the amount and the percent of the annual debt repayment obligation in your annual operation budget?
Sustainability
If so, what are your plans for sustaining this program or service? If applicable, address your ability to leverage additional funds.
If your organization should experience a delay or loss of revenue, do you have a reserve fund? If so, how long will those funds allow you to continue operating? If you do not have a reserve fund, what are your contingency plans?
Fundraising
Please briefly describe and give dates for any fundraising activities that you plan to hold between July 2019 and June 2020.
If so, please describe.

Part IV - Budget and Documentation

Use our budget worksheet found at the top of this application form.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Use our fiscal summary worksheet found at the top of this application form.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Use our Signature Certification form found at the top of this application form.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Use our Self Certification checklist found at the top of this application form.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Upload a copy of your most recent Board of Director's meeting minutes.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Most Recently Completed Financial Review or Audit and Management Letter – Financial Review or Audit must completed by an Independent Public Accountant (Financial Review required for budgets between $100,000 and $250,000; Audit required for budgets over $250,000)* *Not required for schools or government agencies. **Schools and government agencies: To bypass the field, please submit a signed letter stating that your organization is a school or government agency.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.
*Not required for schools or government agencies. **Schools and government agencies: To bypass the field, please submit a signed letter stating that your organization is a school or government agency.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.
*Not required for schools or government agencies. **Schools and government agencies: To bypass the field, please submit a signed letter stating that your organization is a school or government agency.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Schools and government agencies: To bypass the field, please submit a signed letter stating that your organization is a school or government agency.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx.
Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf doc docx xls xlsx.