United Opticians Association Grant Application

Mission Statement and Objectives
Mission Statement*
Please provide the mission statement of your organization.
Corporate Status (entities only)

501 (c)(3)501(c)(6)For ProfitOther
Project Title*

Provide a brief summary of the project0/250
Objectives*
List the main mission and key objectives of this project. Be specific about the goals you aim to achieve as a result of any funding received.

Target Population and Need Assessment
Target Population*
Describe the target population for your project (e.g., age groups, specific communities, geographical areas, profession, etc.).
Need Assessment*
Provide a detailed explanation of the needs of the target population. Include any relevant statistics or data to support your assessment.

Project Plan and Implementation
Detailed Project Plan*
Describe the specific activities and strategies you will use to achieve your objectives. Include a timeline for implementation.
Key Personnel/Contractor(s)*
List the key personnel and/or independent contractors involved in the project and their qualifications. If any of these key personnel related to administering this project are being compensated by you, please provide the total annual compensation (or, if applicable, contract payments) received for each such individual or entity regardless of the extent to which such individual or entity is utilized on this particular project
Partnerships and Collaborations*
Identify all partners or collaborators involved in the project and describe, in detail their roles
Previous and/or Current Grants, Awards, Sponsorships or Scholarships*
Identify and provide all details of any previous funding received by you in the past ten (10) years, providing the following details for each separate source of funding: 1. Amount 2. Source 3. Requirements for use 4. Details of outcome 5. Other key information demonstrating correlations between the funding and outcomes achieved

Outcome-Driven Goals and Evaluation
Outcome Goals*
Describe the desired outcomes of your project. What specific changes or improvements do you expect to see?
Evaluation Plan*
Explain how you will measure the success of your project. What metrics or indicators will you use to evaluate outcomes?

Budget and Funding
Total Project Budget*
Provide the total budget for the project.
Budget Breakdown*
Provide a detailed budget breakdown, including specific expenses (e.g., personnel, equipment, supplies, travel).
Funding Request*
Specify the amount of funding you are requesting from this grant.
Other Funding*
List any other sources of funding for this project, including amounts and status (e.g., secured, pending).

Sustainability and Impact
Sustainability Plan*
Describe your plan for sustaining the project beyond the grant period.
Long-Term Impact*
Explain the long-term impact you expect your project to have on the target population and community.

Supporting Documents
Proof of Non-Profit Status

Include proof of your organization’s non-profit status.
Cancelof
Letters of Support*

Attach letters of support related to your organization’s mission.
Cancelof
Letters of Support*

Attach letters of support from partners, the targeted population, or community leaders related to this project.
Cancelof
Financial Records (organizations only)

Attach copies of all filed tax returns for the past five (5) years
Cancelof
Financial Records (organizations only)

Attach copies of all of the Organization’s Financial Statements for the past five (5) years
Cancelof
Have the Organization’s Financial Statements been audited by an independent auditor in any of the previous five (5) years?*

YesNo
Financial Records (organizations only)

If yes, please provide cop(ies) of all such audited statements for each year in which an audit was conducted.
Cancelof
If no, please explain why no such audit has been completed in each year in which an audit was not conducted
Have the Organization’s Financial Statements been reviewed by an independent accountant in any of the previous five (5) years?*

YesNo
Financial Records (organizations only)

If yes, please provide cop(ies) of all such reviewed statements for each year.
Cancelof
If no, please explain why no such review has been completed in each year in which a review was not conducted
Additional Documents

Include any other relevant documents that support your application.
Cancelof

Certification and Signature
I certify that the information provided in this application is true and accurate to the best of my knowledge.

o I understand that any funding received is contingent upon completion of a post-grant report, providing all receipts, documentation of all activities, and reporting on all outcomes achieved, as well as explanation for any outcomes that were not achieved, within thirty (30) days following completion of any such project.

o To the extent that this project is anticipated to extend for a time period exceeding six (6) months, I agree to provide periodic updates on the progress of this project, no less than every three (3) months.
Signature*

Clear
Name*

First NameLast Name
Title*
Date of Signature*

MonthDayYear
Date
For any questions or further assistance, please contact: grants@opticians.org

Thank you for your application. We look forward to supporting your educational and professional journey in the field of Spectacle or Contact Lens Opticianry.
Should be Empty:

Applicant Information