1.Introduction
• Name, address, phone, fax and e-mail address(es) of executive director and primary contact person;
• Type of request (special program or project, organizational effectiveness, continuing program support, etc.);

• Amount of request.

2. Request
• Brief description of your organization including mission, goals, short history, date founded and summary of current and planned program(s);
• Description of the objectives and activities for which funds are requested;
• Evidence of need for your organization or project;
• Explanation of how your request addresses the Foundation’s guidelines and special concerns;
• Description of the population served including: geographic area(s) served; number of persons served (by individual program if available); and ages, income level(s), and special needs of individuals served;
• Evidence of your capacity to manage the program or project for which funds are requested, including the qualifications and experience of the key staff responsible for management of your organization and project and the number of full-time equivalent employees (FTE).

3. Evaluation
• Description of the expected outcomes of your program or project, in terms of real changes in the lives of your constituents;
• Description of how you will know that you have achieved these outcomes, i.e. the outcome indicators you have identified and the methods you will use to measure your progress.

4. Fundraising
• Description of your future fundraising plans to support this project;
• Statement of the percentage of your annual operating budget (and project budget, if applicable) which is expended on direct fundraising costs;
• Statement of the percentage of your annual operating budget which is expended on lobbying activities, if applicable.   (continued on next page)