2015 DISCRETIONARY GRANT APPLICATION

Transcription

1 2015 DISCRETIONARY GRANT APPLICATION I. Discretionary Grant checklist Review this checklist as the first step in preparing your Application, and once again before submitting your application to make sure it is complete. Please refer to the 2015 Discretionary Grants Guidelines for details. The deadline for completed grant applications is August 31, For questions, contact or Please do not use binders, folders, or covers. Secure multiple pages with staples or binder clips. Your answers are limited to the space provided and must be single-spaced in 12-point type. ONE ORIGINAL DISCRETIONARY GRANT APPLICATION One (1) original Grant Application Form signed by the Executive Director/CEO and the Board Chair and marked ORIGINAL (mailed or delivered) AND a copy of the application ed as an attachment to aacf@daytonfoundation.org. If additional information was requested in the LOI Acceptance Letter, please provide a narrative (not to exceed one page) and attach it to your Application. Attachments: one copy of each of the following with mailed packet (not as attachments) IRS Form 990 and current balance sheet/income statement A list of your organization s officers, directors and staff and a copy of your organization s diversity policy. A copy of your organization s IRS Tax Determination Letter 501(c)(3) designation SUBMITTING GRANT APPLICATION Mail or your completed application to: African-American Community Fund, c/o The Dayton Foundation, 40 N. Main Street, Suite 500, Dayton, Ohio aacf@daytonfoundation.org To be considered, the application package must be complete according to this checklist. Applications must be postmarked on or before the deadline date (August 31, 2015). Incomplete or late proposals will not be reviewed. The Dayton Foundation s staff is NOT authorized to extend the application deadline.

2 AFRICAN-AMERICAN COMMUNITY FUND 2015 DISCRETIONARY GRANT APPLICATION Application Deadline: August 31, 2015 II. GENERAL INFORMATION Organization Name: Federal Tax ID#: Mailing Address: Executive Director/CEO: City, State, Zip Code: Organization Phone Number: Executive Director/CEO Address: Website Address: Organization s Current Annual Budget: Amount Requested from AACF: Project/Program Budget: Program start date: Program end date: Name and Title of Contact for this Grant: Contact Phone Number and Address: Purpose of Grant: 1

3 III. PROJECT/PROGRAM DESCRIPTION 3.1 The issue or need: Describe the issue or need the grant will help to address and how the issue was identified. 3.2 Geographic region served by this Program/Project: Describe the demographic region that is the focus of the proposal, preferably using percentages if available. 3.3 The Strategy: State specifically how this project/program will be implemented to improve the issue or need. 3.4 Evaluation: Describe how the project/program s success will be assessed and measured. 2

4 IV. PROFILE OF YOUR ORGANIZATION 4.1 Overview of the organization, including the mission/purpose and age of organization: accomplishments, initiatives, etc. 4.2 Brief description of current programs/projects and activities: 4.3 Who are the key staff members involved with this program/project? Please describe their qualifications: (This can include volunteers, paid staff, collaborative organizations). 3

5 4.4 Will additional staff, consultants or outside resources be required for this project? If so, please explain. Provide job descriptions, if appropriate: V. FUNDING AND SUPPORT 5.1 Other Support for this Project: AACF could require additional funding sources for any projects we support. Please list below the other funds that have been received, are pending, or are potential for this project. Source Funds Received or Committed: Amount Committed Conditions/Purpose Requests Pending: Source Amount Expected Response Conditions/Purpose Potential/Prospective Funders: Source Amount Expected Response Conditions/Purpose 4

6 5.2 Financial Sustainability: AACF does not commit to continued funding. If this project will be ongoing, outline the strategy to secure funding support, once the awarded AACF discretionary grant funds are expended. 5.3 Collaboration: Will the organization collaborate with other organizations on this particular program/project? (If so, with whom and how?) 5

7 VI. EVALUATION 6.1 What are your goals and objectives for this program/project? If a grant is awarded to the organization, AACF will require a written report, within sixty (60) days after the completion of the program/project, including information on success of the program/project and how the grant award monies were utilized. 6.2 What are the measurable short term and long term outcomes of this program/project and how will the outcomes be measured? 1. OUTCOME DETAILS HOW WILL OUTCOME BE MEASURED? SHORT-TERM (S) LONG-TERM (L)

8 VII. FINANCIAL INFORMATION 7.1 STATEMENT OF REVENUE AND EXPENSE FOR MOST RECENTLY COMPLETED FISCAL YEAR Name of Agency: Time Period: Corporate and foundation grants Government grants and contracts Contributions and other gifts United Way Program service fees Special events, fundraisers Other revenue (please list): REVENUE/SUPPORT Total Revenue $0.00 EXPENSES Salaries, employee benefits and taxes Professional fees and/or client assistance Occupancy/rent Depreciation Development/marketing General operating expenses (please list): Total Expenses $0.00 REVENUE LESS EXPENSES $0.00 If expenses exceeded revenues, please explain. Accompanying one-page narrative welcome if additional explanation is warranted. 7

9 7.2 TOTAL AGENCY BUDGET FOR CURRENT FISCAL YEAR Name of Agency: Time Period: REVENUE/SUPPORT Corporate and foundation grants Government grants and contracts Contributions and other gifts United Way Program service fees Special events, fundraisers Other revenue (please list): Budget For Year Actual Year To- (specify date ) Total Revenue $0.00 $0.00 EXPENSES Salaries, employee benefits and taxes Professional fees and/or client assistance Occupancy/rent Depreciation Development/marketing General operating expenses (please list): Total Expenses $0.00 $0.00 REVENUE LESS EXPENSES $0.00 $0.00 If expenses exceed revenues, please explain how difference will be offset. Accompanying one-page narrative welcomed if additional explanation is warranted. 8

10 VIII. PROJECT/PROGRAM REQUEST BUDGET Name of Agency: Time Period: (Items typical for operating a program) REVENUE Corporate and foundation grants Government grants and contracts Contributions and other gifts United Way Program service fees Special events, fundraisers Other revenue (please list): BUDGET EXPENSES Salaries, employee benefits and taxes Professional fees and/or client assistance Occupancy/rent Depreciation Development/marketing General operating expenses (please list): Total Revenue $0.00 Total Expenses $0.00 REVENUE LESS EXPENSES $0.00 If expenses exceed revenues, please explain how difference will be offset. Accompanying one-page narrative welcomed if additional explanation is warranted. 9

11 ACKNOWLEDGEMENT OF THE AFRICAN-AMERICAN COMMUNITY FUND DISCRETIONARY GRANT APPLICATION POLICIES The Executive Director/CEO and Board Chair have reviewed this application and understand and assure that: The applicant is eligible for funding and requests support for activities eligible for funding. (Please see the Application Guidelines for details); This application is complete according to the Grant Application Checklist (Section I); Should AACF award a grant to the organization, the applicant agrees to include AACF in any literature and/or advertising regarding the program/project, acknowledging the grant monies received from AACF. The applicant also agrees, should AACF award a grant to the organization, to allow AACF to schedule a presentation with the organization and organization staff. This presentation will give the organization a better understanding of AACF; AACF will notify applicants in writing of its decision. Grant recipients will need to return a signed grant acceptance form prior to the release of funds. Recipients also must agree to adhere to the terms of the grant throughout the grant period. A status report is due within six (6) months, or by April 29, 2016, and a final program report and financial report are due by October 31, Grant awards typically are $2,000 or less; This application is part of an open competition. Applications are selected for more detailed evaluation based on the contents of this application form. The applicant has clearly and completely described its mission, programs, populations served, request for funding, strategy and impact through anticipated outcomes on this form; and Organizations that are declined may apply again by the next deadline, if they wish. Organizations that are funded are eligible to apply again after the grant funds have been paid and the final report has been submitted and approved. Executive Director/CEO/or Other Authorized Organization Representative Board Chair or Other Board Representative CONTACT PERSON FOR THIS GRANT: Name/Title Phone Number and Extension Address 10