Organization Information
Client Demographic Information
Contact Information
Executive Director/President/CEO
Primary Contact for Request
Request Information
Goals and Objectives
Financial Information
Financial Summary
Income Sources
|
Abington Foundation Application |
Organization Information | ||
| Organization Name | ||
| Address | ||
| City | ||
| State | ||
| <Select One> | ||
| Zip Code | ||
| Phone | ||
| Website | ||
| Federal Tax ID | ||
| 0 | ||
| Tax Status | ||
| <Select One> | ||
| Organization Background | ||
| Provide the mission and a brief history of the organization, including the year it was founded and how it has evolved since it was founded. (200 word limit) | ||
| Staff Information | ||
| How many staff members do you have in each of these categories: full-time, part-time, interns and volunteers. | ||
| Programs and Services | ||
| Without repeating the information in the Organization Background field, list the organization's programs, along with a brief description and number served in each during the last fiscal year. For example, XYZ operates the following programs (with 2009 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). (300 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 zero here. | ||
| Description of Clients Served | ||
| Provide any other detailed information not reflected in the numbers above about the population you serve. | ||
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 | ||
| Request Amount | ||
| Whole numbers only | ||
| Type of Support | ||
| Project/Program Title | ||
| Please briefy 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 | ||
| Length of grant | ||
| (In whole months) | ||
| Project Description | ||
| Please summarize the overall program/project to be funded by this grant, incuding the number of clients to be served. (200 word limit) | ||
Goals and Objectives | ||
| List the goals and objectives for the program/project, i.e., what do you hope to achieve? Select the three most significant and enter them into the fields below. | ||
| 1. Goal/Objectives | ||
| 2. Goal/Objectives | ||
| 3. Goal/Objectives | ||
| Activities | ||
| List the activities for the program/project, i.e., what will you do? Please be specific and include numbers to be served, services provided, locations and timeframe. | ||
| Outcomes | ||
| List the outcomes you hope to achieve with the program/project, i.e., how will you measure success? Please be specific, including what staff, tools or other resources will be used to measure outcomes. | ||
| Evidence of Success/Accomplishment | ||
| What data or evidence suggests that this approach will be effective? Responses may include information about numbers of clients served in the past by this program/project, use of best practices, evaluation data, or organization or program accomplishments. | ||
Financial Information | ||
Financial Summary | ||
| The following information must match the audit or Form 990 that is included with your request. Please refer to your organization's audit or Form 990 and current operating budget when answering the following questions. | ||
| Fiscal Year (start date) | ||
| What was the start date of the fiscal year? | ||
| Fiscal Year (end date) | ||
| What was the end date of the fiscal year? | ||
| Expenses | ||
| What were the organization's total expenses during this time period? | ||
| Income | ||
| What was the organization's total income from all sources during this time period? | ||
| Change in net assets | ||
| Did the organization experience an increase or decrease in net assets during this time period? Enter "increase" or "decrease" here. | ||
| Change in net assets | ||
| What was the amount of the increase or decrease? | ||
Income Sources | ||
| List all the income sources as a percentage of the total income listed above. For example, if the organization's total income was $500,000 and $150,000 was raised from foundation grants, the percentage for the Foundation category is 30. If your organization does not receive income from one of the sources listed, enter a zero. If your organization receives income from a source not listed, enter this amount in the other category. Enter only a whole number, without the %. The total must equal 100%. | ||
| Corporations | ||
| Government | ||
| Foundations | ||
| Fees for Service | ||
| Individuals | ||
| Board | ||
| Special Events | ||
| Investments | ||
| Bequests | ||
| Donated Services | ||
| United Way Services | ||
| Other | ||
| Total Income Sources | ||
| Press the calculator icon to ensure that the total is 100% | ||
| 0.00% | ||
| Net Assets | ||
| The organization's net assets at year's end may include several categories (property, equipment, cash, investments, etc.). Give the amounts for these categories below as listed in the financial document. Enter the total net assets at year end here. | ||
| Property and Equipment | ||
| Enter the amount/value of property and equipment after depreciation | ||
| Cash and Cash Equivalents | ||
| Enter the amount of cash and cash equivalents | ||
| Investments | ||
| Enter the amount/value of investments | ||
| Endowment | ||
| Enter the amount/value of the endowment | ||
| Current Operating Budget | ||
| Enter the organziation's operating budget (total expenses) for the current fiscal year | ||
| Description of Finances | ||
| If necessary, you may provide more detailed information to explain or support the numeric information provided above. For example, if the organization experienced a significant increase or decrease in net assets you might explain the circumstances. If there is an increase or decrease in the organization's operating budget, you might explain the circumstances. | ||