Grant Application Tell Us About Your OrganizationFederal Tax ID #Organization NameLegal Name of Organization (If Different)Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeTell Us About YouPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameMiddle NameLast NameStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodePhoneEmail AddressTell Us About Your Organizational LeadershipPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameMiddle NameLast NameStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodePhoneEmail AddressYour Organization's ImpactPlease provide a brief history of the organization and description of existing services, current programs, and accomplishments, as well as current number of staff members (full-time, part-time and volunteers). If there are any social media accounts for the organization, please provide those handles as well.Include a description of the proposed program for which you are seeking grant funds.Please state if this is a new or existing program.NewExistingIf existing, include a detailed timeline to explain how long it has been in operation beginning with the initial roll-out of the program through present day, including any and all accomplishments to date. Also include a detailed timeline outlining the next phases of the program including how staffing and finances will be sustained for the remainder of the program along with an anticipated date of completion.If the program is not already in existence, please include a detailed timeline including the desired start date all the way through the anticipated date of completion for the program. Please note how staffing and finances will be sustained for this program.Explain how your work will benefit, and add, to the success of The Human-Animal Alliance’s mission.How do you define your organization’s success?Detail any factors that distinguish your program from others that provide similar services.What is most important for the Human-Animal Alliance to know about your organization?What do you need in order to achieve the parameters of your program?Provide a list of challenges that may be crossed and how to overcome them.List geographical areas for the program.Which of the 4 Pillars for The Human-Animal Alliance does your program fall under?ResearchProviding Animals to PeopleKeeping People and Animals TogetherEducationYou may choose more than one.Note the specific dollar amount requested from the Foundation as well as the date payment is needed.List all entities you have sought after for financial support to the proposed program (include their responses to date - or note that they are only a potential source – along with the dollar amount committed, if applicable).Outline a plan for evaluation throughout the extent of the program (please include details of the information to be collected, timelines for the collection of this data, and how progress will be measured) to ensure its success by staying on task.State specific goals and anticipated outcomes/success indicators of the program. If an existing program, state the outcomes and goals met in the most recent years.Illustrate how you have used/will use evaluation results to make changes and/or improve the performance and impact of program.Is there a need, or opportunity, for non-financial support as well?YesNoIf yes, please describe.What is the specific need or opportunity?List the trustees, or directors and corporate officers, along with titles and number of years served on board for the board of directors.List names of staff members involved with the proposed project along with their qualifications. If there is a point person for the project or someone with creative control over the project, please include their name, title, and full contact details such as phone and email.FinancialsWhat is the fiscal year end date of your organization?Organization’s current operating budgetUSDTotal RevenueUSDTotal ExpensesUSDTotal Net AssetsUSDChange in Net AssetsUSDTotal LiabilitiesUSDUnrestricted Net AssetsUSDTotal Annual Operating BudgetUSDBoard Approved Budget Protection - RevenueUSDBoard Approved Budget Protection - ExpensesUSDPercent of Total Expenses Allocated Toward Admin CostsCurrent Value of EndowmentUSDValuation DateIf operating deficit – provide amount and explanation and whether it was a planned deficit or not.Finalize ApplicationPlease note any previous conversations you may have had with a Human-Animal Alliance Staff Member regarding this project.Please include any additional notes you feel are pertinent to your project and proposal.I certify this Grant application accuracy.Start signing your signature hereYour browser does not support e-Signature field.I certify Grant consideration.Start signing your signature hereYour browser does not support e-Signature field.Please upload each of the following documents. Your organization’s mission statement. Provide a program budget which includes both income and expenses. Provide your organization’s current program budget revenue and expenses, if already underway. Provide your organization’s previous revenue and expenses, if program was already in existence. The last certified audit or the last fiscal year’s statements and IRS Form 990 filed should it be a younger agency. A copy of the latest verification of tax-exempt status from the IRS under Section 170 of the IRS code. Upload Your Documents HereDrag and Drop (or) Choose Files2MB Per File LimitSend MessageSave as Draft
