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* 1. Primary Contact Name

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* 2. Primary Contact E-mail

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* 3. Organization Name

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* 4. Focus Area Alignment
Which of the following focus areas does your organization align with most closely? (Please select one)

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* 5. Incorporation Date

Date

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* 6. Mission Statement

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* 7. Board Members
Please include a link to your website or other online resource listing your board members. If unavailable, you may provide the list below.

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* 8. Board Activity
Does your board meet regularly, maintain an active committee structure, enforce terms, and recruit new members periodically?

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* 9. Executive Staff
Please include a link to your website or other online resource listing your executive staff. If unavailable, you may provide the list below.

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* 10. IRS Determination Letter
Upload a copy of your IRS Determination Letter. If you are working with a fiscal sponsor, please upload their IRS Determination Letter instead.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 11. Current Operating Budget
Upload your organization’s current operating budget. (The preferred budget range is $1–5M.)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 12. Budget Narrative
Please also share any other details you want the committee to know about how this funding will/won’t impact your organization’s ability to do the proposed work. Provide any additional details about your budget attachment that you want reviewers to be aware of.

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* 13. Statement of Need
Describe the specific challenges or gaps in the community that your organization addresses.

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* 14. Goals, Outcome & Evaluation
What are your key goals and outcomes, and how do you measure success (e.g., key KPIs)?

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* 15. Impact to Date
Share measurable outcomes or evidence of success your organization has achieved so far.

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* 16. Grant-Specific Goals
What specific goals or outcomes will this grant help your organization accomplish?

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