ODA Foundation 2025 Access to Care Grant Application

Access to Dental Care Grant

Please make sure you have read the Access to Care Grant 2025 Proposal Guidance document and have all required portions of the proposal ready to submit. You will not be able to save and come back later to finish this online submission, it must be completed and submitted in one session. Complete all questions and upload all required documents. Failure to complete all required sections fully will result in an incomplete proposal which will not be reviewed for a grant. If you have any questions or difficulties with this online submission, please contact Mollie Greenlee, Manager of the ODA Foundation at mollie@oda.org.
Organization Information
Organization Name (legal)*
Organization d.b.a. Name (if different than above)
Organization's Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NoYes, please provide name of supporting organization below
Name of supporting organization, if you answered yes above
Grant Contact Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Format: (000) 000-0000.
Website*
501c3509a3
Organization's Tax ID Number*
Date incorporated*
IRS Determination Letter
Upload your IRS determination letter to show 501c3 or 509a3 status. File must be in PDF format.*

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Free clinicFQHCHospital/Hospital FoundationFoundationUniversity/University FoundationOther
County/counties where organization provides services:*
Total organizational budget 2024*
Total organizational budget 2025*
Organization 990 or Audited Financial Statements
Upload the organization's most recently available 990 or audited financial statements. Upload must be in PDF format. *

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Program/Project name for which funding is requested*
Requested ODA Foundation Grant amount*
Total project expenses for the program/project (should match expenses provided on budget)*
Transmittal Letter
Include the Letter of Inquiry previously sent to the ODA Foundation, updated with any changes to the project, cost or amount requested from ODA Foundation. Transmittal letter must be signed by the executive director or board president. Upload must be in PDF format. *

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Proposal Narrative
Include all headings and subheadings as outlined in the Access to Care Grant Proposal Guidance. Narrative should not exceed five pages (Arial 10pt Font single-spaced). Upload must be in PDF format. *

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Budget and Quotes
Budget Form
Upload your completed budget form from the Access to Care Grant Proposal Guidance. Budget should account for all expenses related to the project for which funding is requested, not just the requested grant amount. If requesting funds for supplies or equipment for general dental clinic use, provided budget should reflect entire clinic budget. In this case, you may substitute a full clinic budget instead of using the ODAF grant budget form. Upload must be in PDF format.*

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Equipment Quotes
If you are requesting funds to purchase equipment, please upload any quotes received for these items. Upload must be in PDF format.

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Letters of Support

Two letters of support are required. One must be from an ODA member dentist involved with the project or local Ohio component dental society and details the relationship or involvement with the organization. The other may be from a partnering agency or other organization/agency involved with or served by the program (other than applicant organization).
Letter of Support: ODA Member or Component Dental Society
Upload your letter of support from an ODA member involved with the project or the local Ohio component dental society. Upload must be in PDF format. *

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Letter of Support: Local organization familiar with your work
Upload your letter of support from a partnering agency or other organization/agency involved with or served by the program. Upload must be in PDF format. *

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Brochures and supporting materials

You may choose to upload patient-centered brochures, annual reports or other supporting materials for your organization you feel would give the ODA Foundation Board of Trustees information helpful in making a funding decision. This is optional. None are required.
Optional: Upload fliers/brochures, annual reports or other supporting materials for your proposal. Files must be in PDF format.

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Grant Contact Signature
I hereby affirm that all of the information supplied by myself and representatives of my organization is correct and truthful and that I have reviewed all required documents and am submitting a complete proposal.

I understand that more information may be requested by the ODA Foundation Director in order to give the ODA Foundation Board of Trustees all needed information to make a funding decision.

I understand that if my organization is selected for an ODA Foundation grant, we will be required to sign a grant agreement prior to receiving any grant funds.

I understand that if my organization is selected for an ODA Foundation grant, we will be required to submit interim and final grant reports as detailed in the grant agreement.
Grant Contact Signature*
Name of Grant Contact*

First NameLast Name
Date signed by Grant Contact*

MonthDayYear
Date
Should be Empty:

Access to Dental Care Grant

Organization Information

IRS Determination Letter

Organization 990 or Audited Financial Statements

Transmittal Letter

Proposal Narrative

Budget and Quotes

Budget Form

Equipment Quotes

Letters of Support

Letter of Support: ODA Member or Component Dental Society

Letter of Support: Local organization familiar with your work

Brochures and supporting materials

Grant Contact Signature