


![]() | Legal name of organization, address, name of | |
| executive director, and contact person other than executive director. | ||
![]() | Telephone number, fax number and email | |
| address. | ||
![]() | Amount requested. | |
![]() | Please summarize in a short paragraph your | |
| funding request and indicate the type of request (operating, project, capital, other). | ||
![]() | List any previous support from The Foundation. |
![]() | A brief description of its history and mission. | |
![]() | Current programs and accomplishments. | |
![]() | Overview of organization's structure including | |
| the number of full- and part-time staff as well as volunteer involvement. | ||
![]() | Total organizational budget and fiscal year end. | |
![]() | Describe your organization's constituents | |
| including the total number and breakdown by age, gender, race/ethnicity, income levels, disabilities, and geography. | ||
![]() | Funding Request — Please describe the | |
| program for which you seek funding, addressing each of the following: |
![]() | Program strategies | |
![]() | Target population | |
![]() | Education and training of those involved | |
![]() | If a service provider, please indicate ratio of | |
| trained experts to autistic individuals | ||
![]() | How many people will benefit from the | |
| proposed project? Please give specific numbers if possible. | ||
![]() | Specific activities and timetable for meeting | |
| your stated objectives. | ||
![]() | How does the project contribute to your | |
| organization's overall mission? | ||
![]() | What do you ultimately hope to accomplish | |
| through your proposed project? | ||
![]() | What are your plans for fully funding and | |
| sustaining this program? | ||
![]() | What other agencies or associations are you | |
| working with on this project? | ||
![]() | How will you measure and monitor the | |
| program's progress and effectiveness? | ||
![]() | What relevant assets and experience does your | |
| staff bring to this project? | ||
![]() | Describe your criteria for a successful program | |
| and the result you expect to achieve by the end of the funding period. |
![]() | IRS 501 (c)(3) Tax Determination Letter. | |
![]() | Most recent financial statement, audited if | |
| available. | ||
![]() | Most recent 990 Form filed with the IRS. | |
![]() | Operating expense budgets for current and | |
| most recent fiscal year. | ||
![]() | List of public/private funding sources for your | |
| organization during the past fiscal year. | ||
![]() | If project funding is requested, please include: | |
![]() | Current expense budget for the project. | |
![]() | List of all sources of income for the program | |
| including committed and prospective, with amounts. | ||
![]() | Specific uses of the requested grant, if possible. | |
![]() | List of Board of Directors, with affiliations. | |
![]() | Organization contact name, address, phone, | |
| fax, and email address. | ||
![]() | Three letters of reference from other | |
| organizations and/or individuals you are currently working with or have worked with in the past. This may include one or two parents whose children have participated in your programs. | ||
![]() | Please do not include brochures or | |
| additional marketing materials. |