Total Amount Requested:
Total Project/Program Budget:
Other sources of support committed thus far for this project/program:
Estimated number of people to be impacted by the program:
Description of the project/program:
Projected timeline for the use of funds (provide start/end dates if applicable):
Explain the overall goal including specific relevant statistics, outputs and outcomes you expect:
Excluding funding, describe any obstacle(s) to the program successfully reaching its goal:
Please describe the targeted audience in terms of population size, demographics, socioeconomic status, age, gender and diversity and specify the percentage of requested funding and outputs that will benefit each demographic:
In what ways does this program address increasing equity in underserved populations, and directly address efforts of inclusion and diversity?
Describe any opportunities for volunteer participation. Do you have a need for skills-based volunteer assistance? If so, what skills are you in need of (marketing, finance, accounting, etc.)?
How will you evaluate the success of the project/program?
Describe how you will communicate these outcomes to the funder:
I certify that my organization does not have a written policy of discrimination on the basis of race, color, religion, national origin, age, disability, genetic information, military or protected veteran status, gender, sexual orientation, gender identity or expression.