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% Refresh 
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)