- Project name:
- Amount requested:
- Project start date:
- Project end date:
- Organization’s mission:
- Target population: Who will benefit from this funding?
- Geographic reach: Where will this initiative be implemented?
- Need: Describe the need for the proposed project, using local data when possible, including information on gaps in services that this funding will address.
- Project description: Please briefly explain (no more than four paragraphs) how the organization will address the needs described above through this project.
- Workplan: Please provide a workplan for your project. You may enter a narrative description in the box below, or you can attach a completed workplan document. There is a workplan template available to help structure your project plan, but you are not required to use this format if you prefer another approach.
- Evaluation: Describe the anticipated health outcomes of the proposed project and how the organization intends to measure them. You may include an evaluation plan here or as an attachment. We have provided an optional evaluation plan template here to outline key items for consideration.
- Community engagement: How will the community or individuals being served be engaged through this project?
- Collaboration: Who will the organization collaborate with to achieve the intended outcomes? This may include other nonprofits, government agencies, community members, local businesses, or other entities. Please include letters of support from collaborative partners as attachments.
- Budget: Please upload a detailed line-item budget and budget narrative describing how the funds will be used. A template is provided if you do not have a preferred budget form.
- Other funding: Please describe any other funding anticipated or committed to this project, including in-kind.
- Attachments: Please include the following attachments:
- IRS determination letter or tax-exempt documentation
- Organizational chart
- Board roster
- Annual operating budget
- Most recent financial statements, 990, or audit
- Letters of support (at least two letters of support are required)
