Bruening Foundation Application |
Organization Information | ||
Organization Name | ||
Address | ||
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City | ||
State | ||
| <Select One> | ||
Zip Code | ||
Phone | ||
Website | ||
Federal Tax ID | ||
| 000 | ||
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) | ||
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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) | ||
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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) | ||
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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. | ||
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Description of Clients Served | ||
| Provide any relevant detailed information not reflected in the numbers above about the population you serve. (100 word limit) | ||
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Contact Information | ||
Executive Director/President/CEO | ||
Prefix | ||
| Example: Mr., Ms. | ||
First Name | ||
Last Name | ||
Title | ||
Office Phone | ||
Extension | ||
E-mail | ||
Primary Contact for Request | ||
Same as above | ||
| No | ||
Prefix | ||
First Name | ||
Last Name | ||
Title | ||
Office Phone | ||
Extension | ||
E-mail | ||
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; goals/objectives; outcomes/indended results and measurement. | ||
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/program below. Examples: for case management services for homeless families; for afterschool programming for middleschool students; for workforce training for low-skilled individuals. | ||
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Project Start Date | ||
Project End Date | ||
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. | ||
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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) | ||
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Program/Project Description | ||
| Give an overview of the program/project to be funded by this request. Be specific. List the activities, services to be provided, clients served, staff who will provide services, locations and timeframe. (200 word limit) | ||
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Goals/Objectives | ||
| List the goals and objectives you have for the program/project, i.e. what do you hope to achieve through the program? Select the three most significant and enter them in the field below. For reference, we offer the following: Goals are long-term aims that you want to accomplish and objectives are specific attainments that can be achieved by following a certain number of steps. Goals and objectives are often used interchangeably, but the main difference comes in their level of abstraction and definition. Objectives are very concrete and defined, whereas goals are less structured. Goals are broad; objectives are narrow. Goals are general intentions; objectives are precise. Goals are intangible; objectives are tangible. (100 word limit) | ||
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Outcomes/Intended Results | ||
| Define successful results/outcomes for this program/project. How will you know whether you have reached your goals listed above? An outcome is the actual result or consequence that will occur through the achievement of the objectives. It is nearly always quantifiable and measurable. (100 word limit) | ||
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Measurement | ||
| How will you measure the results listed above? Please be specific, including what staff, tools or other resources will be used to measure outcomes. (100 word limit) | ||
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Alignment with Foundation's Interests | ||
| Please explain how this program/project fits with the Foundation's interests of either Learning or Safety Net Services and what specific area is being addressed. Please see grant guidelines here: http://www.fmscleveland.com/bruening/grantGuidelines.cfm (100 word limit) | ||
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Best Practices | ||
| The Bruening Foundation is interested in supporting organizations that implement best practices or evidence-based programmng. If your program/project fits this criteria, please explain or provide information to demonstrate. (100 word limit) | ||
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Project Budget | ||
| What is the total cost of the program/project? Whole numbers only. (PDF copy of budget will be attached on a later page). | ||
Program/Project Sustainability | ||
| How will you support this program/project financially in the long term? Be specific about funding sources. (100 word limit) | ||
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