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 (please include street address if different from mailing 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 grant from another

foundation or donor? (Please circle) _____YES _____ NO

If you answer yes please tell us about the nature of the challenge grant.

____________________________________________________________________________________

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 board approved 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.

12. A Year to date Financial Statement to be submitted separately, as an attachment, including the

time period the statement covers: _____/_____/______ to ______/_____/______

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. Please include a List of Anticipated Funding Sources with dollar amounts, indicating specific sources

and which are committed, pending, or anticipated.

9. 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.

* Expenses: provide a line item expense budget, with narrative footnotes for those applicable items

that need further explanation.

* Please note where general operation funding is requested the Organization Budget would be the Project

Budget, although additional details may be needed to account for possible Foundation funding.

Please send three (3) hard copy sets of the following Written Grant Proposal responses:

1) The Cover Summary

2) The Organization Profile

Include the Organization Budget and the Year to Date Financials as separate documents

3) The Proposal Narrative

Include the Project Budget and List of Anticipated Funding Sources as separate documents.

Additionally, please send one copy of each of these items as an email attachment* to

Ms. Smith at: 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 greatly preferred. You may be asked to re-submit incompatible formats.

To complete a Master Application:

Please send one (1) hard copy of each of the following Additional Documents:

1) A listing of corporations, foundations, and individuals being approached to fund the current

proposal, with dollar amounts and indicating which sources are committed, pending, or anticipated.

2) The IRS letter confirming tax-exempt status under section 501(c)(3) of the Internal Revenue Code.

3) 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, or if none is

available their most recent tax filing.

4) Current Board listing with relevant background information on the members including city or

town of residence, positions held, and other affiliations.

5) A listing of principal staff people including relevant background information on each one.

6) Most recent independent audit. If none is available, most recent tax filing.

*In the event you are unable to email this group of documents please file four (4) additional hard copies of

each item for a total of seven (7) sets.