Moen Grant Application

Use this application to request funding for a specific new equipment project or educational program benefiting youth ages 0–18 with physical or cognitive impairments. Attach additional pages when needed.

Eligibility and funding requirements

Eligible applicants are 501(c)(3) nonprofit organizations, public schools or public school districts, and government entities. Organizations may apply on behalf of an individual youth or a group. Funds are awarded to the approved organization, not directly to individuals or families.

Applicant organizations must be located within the Astera Health service area, including Bertha, New York Mills, Sebeka, Menahga, Verndale, Henning, Wadena, and surrounding communities served by Astera Health. Youth benefiting from grant funds must also reside within this service area. Eligibility is based on communities rather than county boundaries. Contact the Foundation if you are unsure whether a location qualifies.

Annual budgets and routine operating expenses are not eligible. An itemized project budget is required. Within three months after project close, recipients must submit documentation of spending and a narrative explaining the impact on youth. Non-identifying information from the narrative may be used in Foundation communications and marketing.

Please complete the following form by October 31, 2026.

Applicants will be notified by November 30 of the award decision of the Foundation Board.
Any questions can be sent to Kim.Beiswenger@asterahealth.org or by calling 218-631-7499.

Legal name of organization

Organization Type

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Primary Contact name and title

NameTitle

Primary contact phone number

Please enter a valid phone number.Format: (000) 000-0000.

Primary contact email

example@example.com

Nonprofits: Attach your IRS determination letter confirming 501(c)(3) status. Public Schools and government entities please provide the official entity name and website below. An IRS 501(c)(3) letter is not required for schools and government entities.

Briefly describe your organizations mission and the people it serves.

0/500

Project name

Type of support requested

Describe the proposed project and exactly what the grant would pay for:

What need or barrier will this project address for youth with cognitive impairment?

Explain why the equipment or program is needed. Do not include youth names, medical records, or identifying health information.

How many youth will directly benefit, and what are their ages or age ranges?

In which communities do the youth who benefit reside?

If the project also serves people outside the eligible age range or service area, how with the grant funds specifically support eligible youth?

Enter "Not applicable" if all participants meet the eligibility criteria.

What specific improvements do you expect this project to make in the lives of the youth served?

Examples include greater participation, access to learning, independence, skill development, connections with others.

How will you determine whether the project made a difference?

Describe what you will track or observe, such as participation, equipment use, skill development, or feedback from youth, families, or educators.

Projected project start date and project close date

Project close is when the planned grant-funded activities or purchases and setup are completed.

What are the main steps to complete the project, and who will carry them out?

Include partners, instructors, or approvals needed before the project can move forward.

For equipment requests, who will own it, where will it be kept, and how will it be maintained and made available to eligible youth?

Enter "Not applicable" for educational programs without equipment purchases.

Will there be costs after the grant-funded project ends? How will those costs be covered?

Total project cost

Amount requested from the Moen Brothers Grant

Attach available price quotes, estimates, or project cost information

Please include any additional response pages if needed here

What other funding or donated resources are available for this project?

identify confirmed and pending support. If none, enter "None."

Could the project proceed with partial funding?

Explain any changes you would make and the minimum funding needed for the project to remain useful.

Who will receive and manage the funds?

Provide the organization name and responsible person's name, title, and contact information of different from the primary contact. If it is the primary contact is the receiver please enter "same".

Applicant acknowledgments (please check each box to acknowledge the following:

Typed full legal name

First NameMiddle NameLast Name

Signature

Date

Attachment checklist

Moen Grant Application

Organization information

Organization eligibility and youth impact

Expected results and project plan

Project budget and funding

Project Budget

Applicant agreement and attachments