AMELIA PEABODY FOUNDATION
GRANT PROPOSAL FORM

On this website at ameliapeabody.org check to be sure that your goals and objectives, as well as the amount of your grant request, match our selection criteria. We would remind you that you should not apply within the twelve months following an earlier grant request, nor should you apply before submitting a final reporting on an earlier grant received.

    
 

COVER SUMMARY:

  1. Legal name of organization: _________________________________________________________

  2. IRS 501(c)(3) nonprofit? (Please circle) ___ YES ___NO
    (If no, identify your fiscal sponsor and attach the signed written agreement from the fiscal sponsor.)

  3. Address ________________________________________________________________________
    ____________________________________________________________________    ___________
    _______________________________________________________________________________

  4. Name of Executive Director _________________________________________________________
    Phone: ______________ Fax: ________________ Email: _________________________________

  5. Name of person completing this proposal if different: ______________________________________
    Title: _________________ Phone: _____________ Email: _________________________________

  6. Grant Amount Requested: $ __________________________

  7. The period this grant will cover: _____/_____ to _____/_____
    ___If a multi-year request please give amounts:
    ___Year One: ___________ Year Two: ___________ Year Three: _____________

  8. Please indicate whether the grant is for (you may check more than one category if appropriate):
    Operations ____________ Program _____________ Capital ______________

    (By Operations we mean the general operations of the organization. By Program we mean a particular program within the general operations, which could be either a new program, or an existing program, or the attempt to lift an existing program up to a new level of performance. By Capital we mean facility purchase, enlargement, renovation or repair, as well as the purchase of new equipment.)

  9. Are you making this request as a challenge or in response to a challenge? (Please circle) ___YES __ NO

    If you answer yes please tell us about the nature of the challenge.
    _________________________________________________________________________________
    ______________________________________________________________________    ___________
    ______________________________________________________________________    ___________

  10. Please summarize your proposal in a few sentences.
    _________________________________________________________________________________
    _____________________________________________________________________    ____________
    ________________________________________________    _________________________________
    ___________________________________________________________    ______________________
    ___________________________________________________________    ______________________
    ___________________________________________________________    ______________________

  11. Please give us a brief profile of your organization in regard to goals and objectives, principal activities, and population and geographical areas served.
    _________________________________________________________________________________
    __________________________________________________    _______________________________
    __________________________________________________    _______________________________
    __________________________________________________    _______________________________
    __________________________________________________    _______________________________
    __________________________________________________    _______________________________

  12. What is your current total annual organization budget: $______________

  13. Total number of staff: Full-time: _______ Part-time: _______ Volunteers: ________

  14. Total number of Board members: ____________ Age of Organization: ___________

  15. List any previous support from the Amelia Peabody Foundation during the past five years.
    __________________________________________________________________________________
    __________________________________________________________________________________
    __________________________________________________________________________________
    __________________________________________________________________________________
    ______________________________________________________    ____________________________


    Signature:_____________________________________________ Date: _____/_____/_____


    Please print your name and title: __________________________________________________

ORGANIZATION PROFILE AND PROPOSAL NARRATIVE:

You should first provide an Organization Profile, and then the Proposal Narrative. If you are requesting an Operations grant, the Organization Profile will be the principal content of your proposal. If you are requesting a Program or Capital grant, you should begin with the Organization Profile, but move quickly on to the Proposal Narrative.

If your request combines elements of an Operations grant and either Program or Capital grant, please provide a full Organization and Proposal Narrative. The following is a list of the type of information you should include in each narrative. This list is not intended to be complete. You may want to add other topics that seem to you important and relevant. The list is meant to help you; you may want to change the order, but please try to limit your written responses to no more than 10 pages total.

ORGANIZATION PROFILE:

  1. State the goals and objectives of your organization.

  2. Who are the people that your organization principally serves? Give a profile of your population by age, gender, income levels, and any other relevant criteria, and indicate the approximate number of individuals in each group. Also, what geographic area do you principally serve?

  3. Give a brief summary of your organization's history, including changes in your mission, if there were any, and key achievements.

  4. Give a brief overview of your organization's present structure and programs.

  5. Tell us about key members of your paid and volunteer staff in regard to their background, experience and qualifications.

  6. Do you rent or own your facilities? Do you work principally from one central facility, or from a number of different facilities in different locations? If more than one, how many are there and where are they located?

  7. What are your greatest strengths? What are your greatest challenges at this time in the life of your organization?

  8. Tell us how you evaluate your organization’s effectiveness in meeting your objectives.

  9. Do you collaborate with other organizations? If so, tell us about those collaborations.

  10. How would you categorize yourselves in regard to your place in the community? A fixture, a newcomer, an innovator, or other?

  11. The Organization Budget, for the current and prior fiscal year, to be submitted separately, as an attachment, should include:
    • Time period budget covers: _____/_____/______ to ______/_____/______
    • Revenues: provide a line item revenue statement for all applicable budget categories
      (Grants and Contracts, Other Fundraising, Program and membership fees).
    • Expenses: provide a line item expense budget, with narrative footnotes for those applicable items, which need further explanation.

PROPOSAL NARRATIVE:

  1. Describe the specific request. How would existing operations, facilities, and/or programs be affected by doing what you propose?

  2. What would be the impact of your request on the population that you serve? Would the impact be the same throughout this population? If not, what group would stand to benefit most and in what way?

  3. Explain how this proposal addresses the needs of your community. If new, community-wide collaborations are envisioned, what are they?

  4. For program or capital grants give timetables and planned activities by means of which you plan to meet your stated objectives.

  5. For program grants describe the extent of staff and volunteer involvement, that is, how much time and how many staff and volunteers, as well as ratios of staff to those served.

  6. Describe your plan for continuing and sustaining the program that this grant would support following the grant period.

  7. What will be your criteria for success? How will you measure success in the short- and long-terms?

  8. The Project Budget, for a program or capital request, should be submitted separately, as an attachment, and should include:
    • Time period budget covers: _____/_____/______ to ______/_____/______
    • Revenues: provide a line item revenue statement for all applicable budget categories. Please include a listing of companies, foundations, and any other sources being approached to fund this proposal, with dollar amounts, indicating which sources are committed, pending, or anticipated.
    • Expenses: provide a line item expense budget, with narrative footnotes for those applicable items which need further explanation.

Please send us seven (7) copies of:

  1. the Cover Summary
  2. the Organization Profile
  3. the Proposal Narrative
  4. the Organization Budget (see no. 11 above in the Organization Profile)
  5. the Project Budget (see no. 8 above in the Proposal Narrative)
  6. Additionally, please send one copy of theses five items as an email attachment and send to: jsmith@ameliapeabody.org

Note: Please put your organization's name in the Subject line. Similarly, attached documents should be labeled with your organization's name rather than the foundation's. Microsoft Word and Excel documents are preferred. You may be asked to re-submit incompatible formats.

 

Please send one copy of each of the following:

  1. The IRS letter confirming tax-exempt status under section 501(c)(3) of the Internal Revenue Code.
  2. If a fiscal sponsor is used please include a copy of their 501(c)(3) as well as a signed statement from them of acceptance of fiscal responsibility. Also include their most recent audit, and if none is available their most recent tax filing.
  3. Current Board listing with relevant background information on the members including town residences, positions held, and other affiliations.
  4. A listing of principal staff people including relevant background information on each one.
  5. A year-to-date financial statement.
  6. Most recent independent audit. If none is available, most recent tax filing.