Important Information:

For reference only. This application cannot be completed. The 2017 grant submission has closed.

I. GENERAL INFORMATION

Date submitted:  

1

Impact 100 Grant Amounts

Select one

$141,000

$141,000

2

Impact 100 Grant Categories

Select One

Please Note: choosing a different category after uploading your documents will delete all your documents and require you to upload them again.

Arts and Culture

Children and Families

Education

Environment, Preservation, and Recreation

Health and Wellness

3

Organization information

Name of Organization

Address

County

Legal Name, if different

City

Phone

State

Zip Code

Website

Mailing address, if different

County

City

State

Zip Code

Executive Director, CEO, or President

Phone

E-mail

Financial Contact Person

Phone

E-mail

EIN Number

Certification: Our organization and its Board of Trustees authorize submission of this proposal. Our tax-exempt status under IRS Section 501(c)(3) has not been revoked or modified. We understand that if we are selected to receive funding, we will be required to provide reports as requested showing how funds were spent and that the funds were spent solely for the purpose for which the grant is sought. We certify that, to the best of our knowledge, the statements contained in this application are true, accurate, and complete. We understand that we will be expected to sign a Grant Agreement if we are the recipient of an Impact 100 grant.

Certification Approval

Executive Director or CEO

Board President

Date

Date

II. ORGANIZATION BACKGROUND

Provide the following information for your overall organization.

1

The Mission Statement and a brief description of your history.

2

Need or problem your organization works to address and the population your organization serves, including: number of individuals, geographic location(s), and relevant demographic information.

3

Current programs and accomplishments. Emphasize the achievements of the recent past.

4

Number of paid full-time staff, number of paid part-time staff and number of volunteers.

5

Total organization budget amount

6

Top five funding sources for the last two completed fiscal years, including names of funders and amounts.

7

List any collaborative relationships—both formal and informal—with other organizations working to meet the same needs or providing similar services. Explain how you differ from these other organizations.

III. PROPOSED PROGRAM

The following section pertains specifically to the proposed program.

1

Proposed Program Title

2

Type of Program

Select one

New program

Expansion of existing program

Duplication of program for new area or population

3

Proposal Summary

75 Words Max

Briefly explain why your organization is requesting this grant, what outcomes you hope to achieve, and how you will spend the funds if a grant is awarded

4

Program General Information

Program Director

Program Director’s Phone

Total Program Budget Amount

E-Mail

Program Activities Location(s)

5

Narrative

Read the instructions for the narrative attachment and provide the requested information for the proposed program for which you are seeking funding.

Instructions for Narrative Attachment:

  • Limit to five pages maximum, which includes the program budget.
  • Send only PDF documents.
  • Type in 12 point font and single-space all proposals.
  • Answer all of the questions in the order listed.
  • Use the numbers and narrative headings listed below.
  • Do not include any materials other than those specifically requested at this time. If you feel it advances your cause, you may refer to links in addition to your website.
  • Note: See Section V below for the attachment upload process..

Content of Narrative Attachment:

Describe the program for which you seek funding. Explain the following:

  1. How the program contributes to your organization’s overall mission.
  2. The specific unmet need(s) you are seeking to address.
  3. How the program will benefit an underserved population.
  4. Innovative strategies you will employ to implement the program and the basis for selecting these strategies. Anticipated length of the program.
  5. Any plans you have for collaborating with another organization(s).
  6. Expected outcomes of the program. Describe the transformative impact the program will have on the community, your organization, and/or the lives of the people you serve.
  7. If this is to be an ongoing program: your sustainability plans, specific sources for future funding once the Impact 100 grant monies have been expended, and your Board’s role in ensuring the continuation of the program. If this will not be an ongoing program, please explain.
  8. The proposed staffing pattern for the program, including the titles and qualifications/bios of key staff members and volunteers
  9. A detailed proposed budget for the program. List each staff line separately and include % of time spent on program. Indicate the specific uses of the requested grant. Include a list of all sources of income toward the program, actual and prospective amounts.
  10. Your evaluation plan. Explain how you will measure the effectiveness of your program. Describe your criteria for a successful program and the results you expect to have achieved by the end of the funding period.

IV. FINANCIAL STATEMENTS

Instructions for Attachment:

  • Submit (a) two (2) consecutive prior years of audited or reviewed financial statements and (b) your most recent interim and, if the audit or review of your most recent annual financial statements is not yet available, full year unaudited/unreviewed financial statements which, taken together, cover the period from the date of the last audited or reviewed statements to the most recent 2017 date available (the most recent 2017 date should be not more than 3 months prior to the application submission date)
  • For example, if your fiscal year end is November and your audited/reviewed financial statements for the year ended November 30, 2016 are not available when you submit your application to Impact 100, you would provide audited/reviewed financial statements for each of the years ended November 30, 2014 and 2015 plus unaudited/unreviewed financial statements for the year ended November 30, 2016 plus unaudited/unreviewed financial statements for the interim period from December 1, 2016 to the most recent date available (preferably, April 30, 2017 assuming a timely submission to Impact 100 by May 18, 2017).
  • The audited/reviewed financial statements should include a statement of financial position (balance sheet), related statements of activities (P&L), functional expenses and cash flows, notes to financial statements and accountant’s report thereon
  • The unaudited/unreviewed interim or full year financial statements should include a balance sheet, P&L and cash flow statement
  • Submit in PDF format only.
  • Note that in Section V Required Attachments below we are requesting, for tracking purposes, that the first prior year audited/reviewed, second prior year audited/reviewed, and unaudited financial statements be submitted as separate documents.

V. LIST OF REQUIRED ATTACHMENTS (PDF only, 6MB maximum each file)

Contact Impact 100 Garden State with any questions.
Email us at grants@impact100gardenstate.org

Completed applications must be submitted by 5PM on May 18, 2017.