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Provide a brief description of your organization, its staff, services and programs. Be sure to
include the date the organization was founded and its mission.
Geographic area served by organization (where possible, identify counties):
Does your agency have a 501(c)3 or other nonprofit designation by the IRS?*
Please select the appropriate response from the list below:
Yes, we have our own status independently
Yes, we have status due to our affiliation with another organization
Yes, we have status as a church
Yes, we have status as a governmental entity
No, we do not currently have a nonprofit status
Is your organization a government agency?*
Does the organization have a strategic plan?*
Has your organization requested funding from ABC before?*
Has your organization received funding from ABC within the past three years?*
If you have received funding from ABC, in what amount(s) and for what
Describe the proposed project and its anticipated impact. Include any relevant data or
supporting statistics and any outcomes that you envision should your request be funded. Please
be specific and avoid generalities.
The maximum grant award is $25,000, and the minimum grant award is $5,000.
What other nonprofit organizations, government agencies, residents, and/or businesses (i.e., all
stakeholders) are working with you on this project?
Explain the relationship of the proposed project to other programs in the community designed
to meet the same or similar needs or opportunities.
How many staff will work on this project? What are their qualifications to accomplish the
Define the time frame of the project and the approximate date the project will be completed.
Evaluations: Baseline Data and Indicators*
Briefly describe the baseline data that is relevant to your project and the indicators you plan to
Evaluation: Expected Changes*
Briefly describe the short-term and intermediate-term changes you expect to result from this
project, and how you will measure those changes. Frame your long-term evaluation to address
these 3 broad questions: (1) How much did we do? (2) How well did we do it? and (3) What
difference did we make?
Proposed Project Budget*
What is the budget for the specific project that ABC funding will support?
Outline all expenses and revenues needed to complete the project described in this application.
You may attach a pdf file of your budget or input the information in the space below.
NOTE: Do not include your organization’s overall operating budget here.
Please list any other key sources of funding for this project, and indicate whether each is
committed or pending. Be sure to indicate any other sources of funding that will require
What are the plans for continuation of this project, including future funding sources?
IRS Letter of Determination
Optional Document Attachment
If you would like to provide a supporting document relating to your project, you may upload a
pdf version here.