Grant Application

Applications are due by May 15, 2017

Tribe or Organization Name *

Department *

Address *

City *

State

Zip Code *

Tribe/Community Served *

Additional Communities Served *

Organization Total Budget * $

Tax ID *

Tax Status *

Program Info & Objectives

Applicant Contact

A representative from your organization who is authorized to enter a legal contract should you receive funding

Applicant Contact Prefix *

Applicant Contact First Name *

Applicant Contact Last Name *

Applicant Contact Title *

Applicant Contact Email *

Project Contact

The person responsible for the day-to-day operations of the project, if different from Organizational contact. This person will be contacted with updates concerning your application.

Project Contact Prefix *

Project Contact First Name *

Project Contact Last Name *

Project Contact Title *

Project Contact Email *

Project Contact Office Phone

Project Information

Required before final submission

Project Title *

Program/Project Duration *

(In whole months)

Project Start Date *

Month

Day

Year

Project End Date *

Month

Day

Year

Program/Project Total Budget * $

Enter just numbers without formatting (example: $5,000 would be entered as 5000)

Program/Project Request Amount * $

Enter just numbers without formatting (example: $5,000 would be 5000)

Objectives

List AT LEAST 1 specific and measurable objective to be accomplished during the grant year. Additional outcomes may be listed (up to 3 total) but AT LEAST 1 is required to be listed here. Each objective listed MUST BE DESCRIBED IN 25 WORDS OR LESS

Each grantee is required to have AT LEAST 1 specific and measurable objective for their program/project. Objectives should state what will be improved or developed, how so, and when?

Definition of an "objective:" An objective should include the measurable intended outcome criteria for success, and when you expect to complete that activity. Intended outcomes are those benefits/impact that you expect will occur for participants during or after their involvement with your project; they may relate to knowledge, skills, attitudes, values, behaviors, condition, or status. By what date or time frame will complete a particular described activity and how will the impact be measured?

Example 1: By March 14, 2018, 20 families will have opened emergency savings accounts with the deposit money we provided.

Objective 1 *

Objective 2 *

Objective 3 *

Program Purpose

Required before final submission

Program Purpose *

In 100 words or less, please describe the purpose of your program.

Program Benefit & Narrative

Program Benefit (300 words or less) *

Summarize the circumstances that led to the need for this program/project and state how this project will benefit Native Communities.

Program Description (500 words or less) *

Enter a brief narrative that describes the anticipated project activities that will be undertaken to reach your goals and how they will be implemented.

Uploads

Upload completed Attachment A

Download Attachment A
Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Upload W-9 Form

Form W-9, Request for Taxpayer Identification Number (TIN) and Certification.
Files must be less than 2 MB.
Allowed file types: pdf.

Upload Tax-Status Documentation

A copy of the organization's or fiscal sponsor's IRS Determination Letter if the applicant is a 501(c)(3) organization or community organization using a fiscal sponsor. Tribal programs and governments should submit proof that they are a federally-recognized tribe.
Files must be less than 2 MB.
Allowed file types: jpg jpeg pdf.

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Applications are due by May 15, 2017