to the 2014-2015 Grant Application in Acrobat PDF Format
Transcription
to the 2014-2015 Grant Application in Acrobat PDF Format
Grant Application Form Jewish Women’s Foundation of South Palm Beach County (JWF) DUE DATE: Monday, December 15, 2014: Applications with all required information and audit report attachments are due in the JWF office no later than 5 p.m., Eastern Standard Time. Complete Grant Applications can be submitted via email to [email protected]. In order for Grant Applications to be considered received by JWF, you must receive an email confirmation of receipt from JWF within two business days. Late Grant Applications will not be accepted. INSTRUCTIONS: Please complete all questions below and number the pages of the Application Form, Proposal Narrative and Program Budget Form and Budget Notes (all in one Word attachment). Please use a 12 point font and adhere to page limits and the application format. Please submit the most recent audit report in a separate PDF attachment from the application. If you have any questions, please contact Lisbeth Rock Cauff, Director of JWF via email at [email protected], or at 561-852-3188. Organization Contact Information: Organization: Program Title: Address: Contact Person and Title: Telephone: Fax: E-mail: Website: Year Organization was Founded: Executive Director (if different than Contact Person): P/JWF 2014 GRANT CYCLE/JWF.Grant.Application.2013-2014.11-21-2013 JWF of South Palm Beach County Grant Application, Page 2 Questions: 1. Is your organization a tax-exempt 501(c) 3? Yes__________ No__________ 2. If not, what organization will serve as your Fiscal Agent? 3. Amount requested: $_______________ 4. Which grant category do you believe your program would fit in best? (Please underline the appropriate category. Please refer to the Grant Categories page on our website for more information.) • • • • ! Economic Security/Legal Reform for Women and Children ! Health and Abuse Prevention for Women and Children ! Education/Leadership Development for Women and Children ! Other Geographic focus (Please underline the appropriate region.): South Palm Beach County U.S. Israel Other (specify): 5. Has your organization applied for funding from JWF of South Palm Beach County in the past? Yes __________ No __________ 6. If yes, did you receive funding? Yes__________ No__________ 7. If yes, when? 8. If yes, how much was the amount for which you received funding? $ _______________ 9. What other Jewish Women’s Foundations within the United States have you applied to? 10. If so, please list which JWFs you have applied. P/JWF 2014 GRANT CYCLE/JWF.Grant.Application.2013-2014.11-21-2013 JWF of South Palm Beach County Grant Application, Page 3 11. If so, when did you apply? 12. If so, what funding amount did you apply for? 13. Are you reapplying for the same program? Yes__________ No__________ 14. If not, how does this program differ from the previous program for which you applied? 15. Number of people to be served by program: _______ 16. How many are Jewish women? __________ 17. How many are Jewish children? __________ Girls: __________ Boys: __________ 18. Number of Board members: __________ 19. How many Board members are Jewish women? __________ 20. Please provide a 50 word Summary of the program for which you are seeking JWF funding: Proposal Narrative: Please attach a Proposal Narrative (maximum of 5 pages in 12 point font) incorporating the following points: 1. Organizational Overview: Provide a brief overview of the agency’s mission and ongoing programs. Who is your organization’s constituency? Be specific about demographics such as gender, religion, age, sexual orientation, race, and people with disabilities. Briefly describe how your organization operates: what are the responsibilities of board, staff, and/or volunteers? If a membership organization, define the criteria for membership. Include a brief paragraph summarizing the qualifications of key individuals involved in carrying out the plans outlined in this request. 2. Problem Statement: In one paragraph, please state what needs or issues the program addresses. 3. Program Description: Describe the program for which support is sought. How does this program address the root causes identified in the problem statement? How will the overall status of Jewish women and/or girls be improved by this program? Please be specific regarding the demographics of the target population including gender, religion, age, sexual orientation, race and people with disabilities. Please indicate if this is a new or ongoing effort. If applicable, please describe how participants will be recruited and whether your organization will collaborate with any other organizations or individuals on this program. 4. Indicators of Social Change: From the list of indicators of social change below, which “shift(s)” best applies to your program and why? If your program addresses more than one of the indicators, please select the top two that most clearly reflect the work outlined in this application. • Attempting to shift definitions and/or reframe issues: The issue is defined differently in the community or larger society as a result of your work. P/JWF 2014 GRANT CYCLE/JWF.Grant.Application.2013-2014.11-21-2013 • • • • 5. JWF of South Palm Beach County Grant Application, Page 4 Attempting to shift individual and community behavior: People are behaving differently in the community or larger society as a result of your work. Attempting to shift critical mass and engagement: People in the community or larger society are more engaged as a result of your work Attempting to shift institutions, systems and policies: An institutional, organizational, or legislative policy or practice has changed as a result of your work. Maintaining earlier progress: As a result of your work, past gains have been maintained, generally in the face of opposition. Goals and Objectives: What are the goals and specific, measurable objectives for the program? Please make sure that your objectives are reasonable and achievable within the funding period, and that they map out a clear strategy for achieving the shift(s) in social change you identify above. 6. Evaluation: How will you know you have achieved the social change shift(s) your organization desires? 7. Who will be involved in evaluating the program -- staff, board, constituents, community, consultants? How will the evaluation results be used? 8. Who is the contact person responsible for submitting the evaluation? 9. Funding Status and Plans: What is the current source of funding for this program? 10. From where else will funding be sought? 11. How will the program be maintained after support from JWF is discontinued? Please be as detailed as possible. Reminder: The JWF awards a maximum of 3 years of support to a program. 12. PROGRAM BUDGET FORM Staff Training Consultants, Professional Fees, Speakers Travel/lodging Food/beverage Equipment Supplies Printing and Copying Telephone and Fax Postage and Delivery Rent Utilities Evaluation Marketing/Advertising/Publicity Other (specify individually) TOTAL EXPENSES 13. SOURCES OF PROGRAM REVENUE A. Total Expenses ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ B. Committed Revenue C. Anticipated Revenue D. (B + C) Total Revenue Grants/Contracts/Commitments P/JWF 2014 GRANT CYCLE/JWF.Grant.Application.2013-2014.11-21-2013 JWF of South Palm Beach County Grant Application, Page 5 Government ________ ________ ________ Foundations ________ ________ ________ Corporations ________ ________ ________ Jewish Federation of SPBC ________ ________ ________ Individuals ________ ________ ________ Earned income (admission fees, etc.) ________ ________ ________ In-kind support (indicate source) ________ ________ ________ Other revenue (please specify) ________ ________ ________ TOTAL REVENUE ________ ________ ________ 14. PROGRAM FUNDS NEEDED Total Expenses in excess of Committed Revenue (Total A minus Total B) Total Expenses in excess of Total Revenue (Total A minus Total D) ________ ________ 15. AMOUNT REQUESTED (cannot exceed $20,000) ________ 16. BUDGET NOTES: Please explain what budget items will cover, variations, or to detail substantial in-kind support such as free office space, volunteer time, etc. Sample: Budget Notes: “Consultant fees requested from JWF of South Palm Beach County will cover: describe nature of consultant’s position(s), necessary qualifications, projected hours, projected cost per hour, projected product(s), projected expenses and supplies, etc. as applicable.” “Staff training expenses requested from JWF of South Palm Beach County will cover cost of materials, space rental, tuition, etc. as applicable.” 17. Please list senior staff members. 18. Please list Board Members and their professional affiliations. Application Check List: Please adhere to the application format when submitting the following items in the order listed below in two files – one with all information except the audit – the audit should be submitted in its own PDF file. All information must be provided in English. In order for Grant Applications to be considered received by JWF, you must receive an email confirmation of receipt from JWF within two business days. Incomplete applications will not be accepted. Required items: Completed JWF Grant Application Form Proposal Narrative (maximum of 5 pages, 12 point font) Program Budget Form and Budget Notes List Sources of Program Revenue with support over $1,000. Please include amounts granted and whether revenue is currently committed or anticipated. List of senior staff members List of Board members and their professional affiliations Most recent audit report (in a separate attachment) P/JWF 2014 GRANT CYCLE/JWF.Grant.Application.2013-2014.11-21-2013 JWF of South Palm Beach County Grant Application, Page 6 Please submit the Grant Application to Lisbeth Rock Cauff, Director of JWF at: [email protected] by 5 p.m. EST on Monday, December 15, 2014. Lisbeth Rock Cauff Director Jewish Women’s Foundation of South Palm Beach County 9901 Donna Klein Boulevard Boca Raton, FL 33428 USA Telephone: 561.852.3188 P/JWF 2014 GRANT CYCLE/JWF.Grant.Application.2013-2014.11-21-2013