Abington Foundation Application

Abington Foundation Application

Organization Information
	Organization Name

	Address

	City

	State
	<Select One>
	Zip Code

	Phone

	Website

	Federal Tax ID
	0000000000
	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)

	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.

	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 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). (150 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

	Current Operating Budget
	Enter the organziation's operating budget (total expenses) for the current 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.

	Description of Clients Served
	Provide any other detailed information not reflected in the numbers above about the population you serve.

	Current environment
	If appropriate, provide context or any pertinent information about changes in your organization's circumstances or client needs that supplement our understanding of why you are making this request.

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

	Prefix

	First Name

	Last Name

	Title

	Office Phone

	Extension

	E-mail

Request Information
	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 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
	Summarize the overall program/project to be funded by this grant. Please provide a short and clear statement about what you propose to do with funds from the Abington Foundation. Including the number of clients to be served. This should be a summary. You will give more detailed information about goals, activities and outcomes below. (100 word limit)

	Numbers served by program/project
	How many individuals will be served by this program/project?

	Numbers served by Abington funds
	How many individuals will be served by the funds requested from the Abington Foundation?

	Project Budget
	What is the total cost of the program/project? Whole numbers only.

	Person person costs
	What is the per person cost of this program/project?

	Income sources for budget
	What dollar amount of the program/project budget do you anticipate will come from charitable and philanthropic contributions (either individual donations or foundation grants)? All income sources should be outlined on the budget that is attached.

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 to achieve the goals listed above? Please be specific and include numbers to be served, services provided, staff who will provide services, locations and timeframe. (200 word limit)

	Outcomes
	List the outcomes you hope to achieve with the program/project, i.e., how will you measure success and if you reached your goals listed above? Please be specific, including what staff, tools or other resources will be used to measure outcomes. (100 word limit)

	Evidence of Success/Accomplishments
	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. (100 word limit)