Grants Application for High Impact Grant -- Basic Information Paralysis-Focus The is paralysis-focused. As such, Quality of Life grant funding must be targeted to initiatives that will serve individuals living with paralysis and their families. Paralysis is defined functionally, as: "difficulty and/or inability to use arms and/or legs due to neurological conditions including but not limited to spinal cord injury, traumatic brain injury, stroke, cerebral palsy, multiple sclerosis, ALS, etc." Please answer "yes" or "no" to the following: We confirm that the proposed project will serve individuals living with paralysis and their families. Yes No Project Name* Character Limit: 100 Please select the type of grant for which you applying. Direct Effect - Open focus-area grants of up to $15,000 High Impact - Targeted high-priority focus-area grants: $30,000 - Transportation Respite/Caregiving Disaster Response $40,000 - Nursing Home Transition $50,000 - Employment Unsure - the Quality of Life grants team will choose based on what you tell us in the Project Description. Grants 1
Direct Effect High Impact Unsure High Impact Priority Focus Area* Please choose the High Impact Priority Focus Area of your invited application from the list below: Transportation Respite/Caregiving Disaster Response Nursing Home Transition Employment Where did you learn about this grant opportunity?* Please select one from the list below. Prior Grantee Word-of-mouth Received flyer The Foundation Center Other If other, please explain. Character Limit: 500 Organizational Information Mission Statement* Please provide your organization's mission statement. (Three paragraphs or less.) Character Limit: 1000 Description of Organization's History and Capacity* Please describe your organization and its capacity to do the proposed project; i.e., how long your organization has been in business; what experience and expertise your organization has in doing the proposed type of work; what makes your organization uniquely qualified to be successful in carrying out this proposed project. (Four paragraphs or less.) Total Annual Operating Budget of the Organization* (Your organization's total expenses for one year.) Grants 2
DUNS Number Please enter your organization's DUNS number. Organizations awarded a grant of $30,000 and above must have a DUNS number. Reeve Foundation Quality of Life grants are federally funded through the cooperative agreement with the Administration for Community Living (ACL), United States Department of Health and Human Services. The DUNS number is a nine-digit number, issued by Dun & Bradstreet (D&B), assigned to each business location in the D&B database, having a unique, separate, and distinct operation for the purpose of identifying them. The DUNS number is random, and the digits have no apparent significance. The DUNS number is a supplement to other identifiers, such as the EIN, and is required whether the application is made electronically or on paper. Dashes are not part of D&B's official definition of the DUNS number. There is no charge to get a DUNS number, and the time to create the number is 24 to 48 hours. https://www.dandb.com/product/companyupdate/companyupdatelogin?execution=e1s1 Federal funding* Applicant organization has received federal funds through grants and/or contracts. Yes No Not sure Federal funding annual total* Please tell us the total federal funding received in 2017. Previous Reeve Foundation Requests* Please check all that apply: Previously requested Reeve Foundation Quality of Life grant Previously awarded Reeve Foundation Quality of Life grant Don't know Grants 3
Proposal Information Project Description Please provide a 2-4 paragraph description of the proposed project, including: what your organization wants to do and why; where and when it will take place, and who will benefit. 0 How many people affected by paralysis will benefit from the project? This number includes people living with paralysis, members of their household, and their caregivers. Character Limit: 8 Targeted population to be served.* Please tell us if your proposed project specifically targets any of the following underserved population groups. Please select all that apply. At-risk of incarceration, current or released prisoners Ethnic Minorities Homeless Indigenous or tribal communities LGBTQ Limited English Proficiency Low Income and or poverty popluations Military service members and or Veterans Newly Injured people with paralysis and their caregivers None of These Other Rural Residents Survivors of violence Age Group of Participants* Please check the following age group(s) of intended participants in your proposed project. Please check all that apply. 0-4 years old 5-12 years old 13-18 years old 19-24 years old 25-45 years old 46-60 years old 61-90+ years old Grants 4
Experience with Work in Priority Focus Area* Please describe how long your organization has worked to address the priority focus area, and how this experience will contribute to the success of the proposed project. Key Staff Responsible for Proposed Project Please tell us about the key staff responsible for carrying out the project, including relevant experience and expertise. Collaborations and Networks Please describe existing and developing collaborations and agency networks that will help to make the proposed project successful. Proposed Client Engagement Please describe the extent to which proposed project stakeholders and/or clients have been identified and/or recruited for participation. Project Timeline Project Start Date Character Limit: 10 Project End Date Character Limit: 10 Activities and Timeline* Please detail specific project activities, timeline and major project benchmarks. Character Limit: 10000 Evaluation If you have not done so already, please read A Quick Guide to Establishing Evaluation Indicators. Please tell us the quantitative outputs and the qualitative outcomes that you will measure to evaluate the impact of your proposed project, and what tools you will use to measure them (statistics on numbers of people served, pre- and post-project surveys, etc.) Grants 5
Budget Information Total Budget* What is the total budget for the entire project? Other Sources of Funding Please list other sources of funding (if applicable) for this project. Please indicate whether the funding is committed or pending. Funding sources may be grouped; i.e., individuals, corporations, foundations, etc. Project Contingency Funding* Please explain how funding requested from this Reeve Foundation grant fits with your overall project budget strategy. If other project funding is pending and subsequently denied, how will the project be funded? What happens if the Reeve Foundation is not able to support the proposed project? Amount Requested Please enter the amount requested from the Reeve Foundation. Please note: Applicants are not required to provide vendor quotes to support budget items such as equipment and consultants or contractors. However, information supporting budget items strengthens the request, and may be included via links to vendor websites in the "detail" boxes below each budget section, or by scanning and uploading vendor quotes using the upload button located at the end of the budget items. Please enter below the amount requested in the following budget categories: equipment; supplies; personnel; travel; consultants/contractors; and/or other. Please leave blank any category for which funds are not requested or enter zero. Equipment Total amount requested for equipment. Grants 6
Equipment Details Please provide details on equipment requested with grant funds, including description, quantity and cost of each item. Personnel Please enter total personnel costs requested. Supplies Please enter the amount requested for programmatic supplies. Supplies Details Please detail the supplies requested for this proposed project, including descriptions and quantities. Personnel Details Please detail role, activities and cost for each employee for which personnel funds requested for proposed project. Consultant or Contractor Please provide total costs for consultants or contractors (service providers not employed by your organization) for the proposed project. Consultant or Contractor Details Please describe activities of consultants or contractors for your proposed project. Travel Please enter travel costs for the proposed project. Travel Details Please describe travel costs for proposed project, including who, why, where and when travel will take place. Grants 7
Other Total other expenses. Other Details Please details any other expenses included in your proposed project. You may upload copies of vendor quotes to support your request using the button below. Vendor Quote Upload Button For multiple quotes, please scan into one document and upload. File Size Limit: 5 MB You may upload other supporting documents such as photographs, newspaper clippings, and flyers using the button below. Other Information Upload Button If you wish to upload optional additional information such as photographs or letters of support, please scan into one document and upload here. File Size Limit: 5 MB REVIEW COMMITTEE NOTES Grants 8