COMMUNITY GRANT APPLICATION - NEW

Status

Status Under Review Approved Denied Tabled / Wrong Application Other Other
Grants are reserved for the Communities in which Holman operates. Please answer the following questions to help us identify which Holman region these funds will be supporting.

Country

Grants are reserved for the Communities in which Holman operates. Please answer the following questions to help us identify which Holman region these funds will be supporting.

Country United States Canada United Kingdom Germany I don't see my location here
State
CA - Closest Metro Area
CO - Closest Metro Area
FL - Closest Metro Area
KY - Closest Metro Area
IL - Closest Metro Area
IN - Closest Metro Area
MO - Closest Metro Area
NJ - Closest Metro Area
OR - Closest Metro Area
TX - Closest Metro Area
WA - Closest Metro Area
Canada - Closest Metro Area
UK - Closest Metro Area
Germany - Closest Metro Area
Organization Profile
Organization Name

Please enter the full name of the organization.
Address of Organization Address of Organization
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Please enter mailing address for the organization.
Organization's Website
Year Organization Founded
Must be 4 digits. Currently Entered: 0 digits.
YYYY
Mission Statement
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
Organization Background
Describe the work you are doing and your expected outcomes. Who is your work benefiting? What differentiates you from others in your field?
Maximum of 1000 words allowed. Currently Entered: 0 words.
Staff Head Count
Full-time Volunteers
Part-time Volunteers
Contact Name Contact Name First Last
Contact Title
Contact's Email
Contact Phone

Please enter digits only! Correct: 8565339894. Incorrect: (856) 533-9894, 856-533-9894, 856.533.9894
Request Information

This is the description of your section break.
Which of the following focus areas does this request align with?

Which of the following focus areas does this request align with? Essential Needs (Food, Housing, and/or Healthcare) Growth and Resiliency (Workforce development and/or Education)
Which of the following essential needs will this request focus on supporting?

Which of the following essential needs will this request focus on supporting? Food Housing Healthcare
Which of the areas of growth and resiliency will this request focus on supporting?

Which of the areas of growth and resiliency will this request focus on supporting? Workforce development Education
Please select the primary population that this request will serve

Please select the primary population that this request will serve Community members experiencing food and housing insecurity and/or limited access to healthcare Community members with low-to-moderate income Other Other
Please list all counties in which people will be impacted by the proposed programming, and denote an estimated percentage of total funding to each county.
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
What is the Grant Purpose?
Briefly describe the project, program, or campaign for which you are seeking funding.
Maximum of 250 characters allowed. Currently Entered: 0 characters.
What is the need in the community you are seeking to address?
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
List up to three goals for this specific request.
Maximum of 200 words allowed. Currently Entered: 0 words.
Describe the specific activities to be undertaken to achieve these goals.
Maximum of 300 words allowed. Currently Entered: 0 words.
Will there be any gaps in existing services or programs that would be met through funding this request?
Maximum of 300 words allowed. Currently Entered: 0 words.
What are the key risks that could prevent this grant from succeeding? What are your plans to mitigate these risks, and how likely are these mitigations to work?
Maximum of 300 words allowed. Currently Entered: 0 words.
How will you measure the impact and success of the project in which the requested funds are allocated? Describe the main indicators you will use to assess progress against your objectives and be specific about the expected outputs and outcomes. How will the impact and success of the project influence ongoing or future work?
Maximum of 300 words allowed. Currently Entered: 0 words.
What is the total amount you are requesting?

Please do not use dollar signs or commas. Correct example: 25000 [indicates $25,000]
Requested Amount to be Paid Over How Many Years?

Requested Amount to be Paid Over How Many Years? One year Two years Three years
Total Budget of Request

Please do not use dollar signs or commas. Correct example: 25000 [indicates $25,000]
Budget Upload: Please attach a copy of your organization’s current annual budget. If this request is for specific program support, please also attach a copy of the relevant budget including detailed income and expense categories and expected co-funding sources.

Attach Files
Budget Narrative: Please provide a budget narrative that clearly connects the activities and objectives described above with the attached budget.
Maximum of 300 words allowed. Currently Entered: 0 words.
Last Available Audited Financial Statement

Attach Files
Additional Information: If there is additional information you would like considered in support of your application, please include it here.
Maximum of 500 words allowed. Currently Entered: 0 words.
Do you have any Holman employees involved in your organization? If so please list their name(s) and what their involvement is (serve on a Board, Committee, regularly volunteer, etc.).
501(c)(3) Federal Tax Exemption Letter of Determination (or International Equivalent documentation)

Attach Files
Optional File(s)

Attach Files

You may upload additional documents here if they will more fully describe your program, event, or organization.
Electronic transfer payments are the preferred method. To proceed with this option, please upload your completed ACH document here, along with a voided check. If you use the following link to access the setup document, it will open in a new window. ACH Setup (PDF)

Attach Files
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Enter Your Email Address *

A special link to resume the form will be sent to your email address.

COMMUNITY GRANT APPLICATION - NEW

Organization Profile

Request Information