Harry & Jane Fischel Foundation

Grant Application

www.fischelfoundation.org

IMPORTANT: All relevant fields must be completed. Fields that are not applicable to you or your organization should be left blank.

Part I – General Information

Legal Name of Organization:
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Contact Person/Title:
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Organization Website:	Email:
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Address:
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Phone Number:	Fax Number:
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Project Name:
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Purpose of Grant (Brief Description):
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Project Dates (Can be approximate):
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Amount Requested: $	Total Project Cost: $
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Is your organization an IRS 501(c)3 not-for-profit?
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How did you hear about the Fischel Foundation?
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INSTRUCTIONS for Parts II and III: Please answer the questions and provide the requested information in the allotted space below. All responses should be provided on this form unless otherwise indicated.

Part II – Details of Organization

Describe your organization

What problems, needs or issues does it address?

Briefly describe your organization’s history and major accomplishments.

Briefly describe your current programs and activities.

Organizational Structure/Administration

Describe how your organization works: What are the responsibilities of the board, staff, volunteers, and, if a membership organization, the members?

Who will be involved in carrying out the plans outlined in this request? Include a brief paragraph summarizing the qualifications of key individuals involved.

Organization Finances

What is your organization's current annual operating budget and what is the source of the funding?

Part III – Details of Grant Request

Describe your request

Describe the project/program for which you seek funding, why you decided to pursue this project/program and whether it is a new or ongoing part of your organization.

Identify others who are addressing the area that this project/program is dealing with.

What are the goals, objectives and activities/strategies involved in this request? What is your timetable for achieving these?

Do you expect to continue this project/program after the funds from this grant are expended? If yes, do you have the funding to continue?

Who is your constituency? How will they benefit from this project/program and/or your organization?

Evaluation

Describe your plan for evaluating the success of the project/program. Who will be involved in evaluating this work (e.g. staff, board, constituents, community, consultants)? How will the evaluation results be used? When will this evaluation be reported to us?

Project Finances

Current project/program budget: Itemize all costs involved and indicate whether they are estimates or final costs. What is the funding timetable for the different stages of the project?

List individually other funding sources for this request. Include amounts and whether received, committed or projected/pending.

Acknowledgement

Indicate the way in which your organization will acknowledge the name of Harry & Jane Fischel in appreciation of the Foundation’s support the project/program.

Other Supporting Material

Attach additional information you feel is relevant, but not covered above, e.g. recent newsletter, articles, evaluations, or reviews, etc. Please use discretion in limiting additional attachments.

IMPORTANT:

Email this completed form to: grants@fischelfoundation.org.

Please note that we do review all applications. We will contact you if we need further information and/or if your application has been favorably considered.

If we contact you for further clarification we may be interested in additional information such as financial statements of your organization.

If you require services of a third party or subcontractor to implement the project/program, you may be requested to list the alternative service providers that were considered, including price comparisons, and provide the formal quotes from each.