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Bruening Foundation Application |
Organization Information | ||
| Organization Name | ||
| Address | ||
| City | ||
| State | ||
| <Select One> | ||
| Zip Code | ||
| Phone | ||
| Website | ||
| Federal Tax ID | ||
| 1 | ||
| Tax Status | ||
| <Select One> | ||
| Organization Background | ||
| In a paragraph, give the mission and a brief history of the organization, including the year it was founded and how it has evolved since it was founded. (150 word limit) | ||
| Staff Information | ||
| In a brief paragraph, describe your staff, including how many staff members you have in each of these categories: full-time, part-time, interns and volunteers. (45 Word Limit) | ||
| Programs and Services | ||
| Without repeating the information in the Organization Background field above, list the organization's programs. Include a brief description and the numbers of clients served in each program during the last fiscal year. For example, XYZ operates the following programs (with current year service figures): child care -- full day program for infants and toddlers 6 weeks to 5 years (40 served); senior lunch program -- congregate meals and activities 5 days a week (120 served); and community garden -- planted and maintained by seniors and teens (50 participated). (150 word limit) | ||
Client Demographic Information | ||
| The information in this section should be reflective of the total clients served by the organization. First enter the total number of clients served and then enter the percentage of clients served in each category. Enter whole numbers only and do not enter a % sign with the number. If you do not have a percentage to enter for the category, enter 0. | ||
| Fiscal Year for Data (start date) | ||
| Provide the start date for the fiscal year for the client data provided below | ||
| Fiscal Year for Data (end date) | ||
| Provide the end date for the fiscal year | ||
| Total number of clients served | ||
| List the total number of clients served by the organization during the fiscal year entered above. Enter a whole number, not a range. | ||
| Percentage African American | ||
| Percentage Asian | ||
| Percentage Caucasian | ||
| Percentage Hispanic/Latino | ||
| Percentage Native American | ||
| Percentage categorized as other | ||
| Total | ||
| Press the calculator icon to ensure that the total is 100% | ||
0.00%  | ||
| Percentage female | ||
| Whole number only, no percentage | ||
| Percentage male | ||
| Whole number only, no percentage | ||
| Percentage of low income clients served | ||
| If you collect income information about your clients, give the percentage of clients served that are below 150% of federal poverty level based on the Health and Human Services Poverty Guidelines. Whole number only, no percentage. If your organization does not collect this information, enter N/A here. | ||
| Description of Clients Served | ||
| Provide any relevant detailed information not reflected in the numbers above about the population you serve. (100 word limit) | ||
Contact Information | ||
Executive Director/President/CEO | ||
| Prefix | ||
| Example: Mr., Ms. | ||
| First Name | ||
| Last Name | ||
| Title | ||
| Office Phone | ||
| Extension | ||
Primary Contact for Request | ||
| Same as above | ||
| Prefix | ||
| First Name | ||
| Last Name | ||
| Title | ||
| Office Phone | ||
| Extension | ||
Request Information | ||
Please note that if a grant is awarded, you will be required to report on the following questions in the grant report form: numbers served by program/project; intended results; organization impact; and community impact. | ||
| Request Amount | ||
| Whole numbers only | ||
| Type of Support | ||
| Project/Program Title | ||
| Please briefly describe your project/program in 10 words or less. You will have an opportunity to fully describe your project below. Examples: to provide counseling services to teens; to increase capacity at the health clinic; for a job training program for low-skilled individuals | ||
| Project Start Date | ||
| Project End Date | ||
| Program/Project Description | ||
| Give an overview of the specific program/project to be funded by this request. List the activities for the program/project specific to this request. Be specific and include the services to be provided, who will be served, staff who will provide serivces, locations and timeframe. (200 word limit) | ||
| Number served by program/project - current fiscal year | ||
| How many individuals will be served in the current fiscal year by the program/project. Whole numbers only. | ||
| Number served by program/project - last fiscal year | ||
| How many were served last fiscal year by the program/project? If this is a new effort, please indicate. (50 word limit) | ||
| Intended Results | ||
| How will this program/project make a difference for the clients you serve? Please be specific and list the results you hope to have. (100 word limit) | ||
| Measurement | ||
| How will you measure these results? Please be specific and list what staff, tools or other resources will be used to measure results. (100 word limit) | ||
| Organizational Impact | ||
| What impact and/or change do you expect in your organization as a result of this program/project? (75 word limit) | ||
| Community Impact | ||
| What impact and/or change do you expect in the community as a result of this program/project? (75 word limit) | ||
| Evidence of Success | ||
| What evidence do you have that this approach has worked in the past or will be effective? You may include information about numbers of clients served in the past by this program/project and any evaluation data; use of best practice information; or organization or program accomplishments. (100 word limit) | ||
| Project Budget | ||
| What is the total cost of the program/project? Whole numbers only. | ||
| Per person costs | ||
| What is the per person cost of this program/project? Please calculate this number by taking the total program/project budget divided by the number of participants directly served by the program/project. Do not include those indirectly served, e.g. audience members, family members, etc. | ||
| Income sources for budget | ||
| What dollar amount of the program/project budget do you anticipate will come from charitable and philanthropic contributions (either individual donations or foundation grants)? All income sources should be outlined on the budget that is attached. | ||
| Program/Project Sustainability | ||
| How will you support this program/project financially in the long term? Be specific about funding sources. (100 word limit) | ||