IMPACT60, Inc. Grant Application

Welcome to the IMPACT60, Inc. Grant ApplicationIf you have any questions, please email us: info@impact60.org

I am applying for an IMPACT60 grant for:* This field is required.

an organization (exisiting or new)

myself/my child(ren)/family

another individual or family

Are you an IMPACT60 Executive Board member?

YesNo

Are you a Performance Columbus Associate?

YesNo

Organization NameProvide the full legal name of the organization below.

Who needs this support?Include the full legal name of the person (or head of household) for whom you are seeking support.

First Name

Last Name

Organization Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

EIN#Organization's or individual's (when applicable) EIN

Organization website addressPlease provide web address or an active social channel below.

Share your relationship to the organization or person(s) for whom you are seeking support.* This field is required.

Name* This field is required.Name of person or individual applicant completing this form.

First Name

Last Name

Email* This field is required.Email of person completing this form.

example@example.com

Address of the individual completing this form.* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

County of residence * This field is required.State the county for the individual/family, or where the organization is located, or the community which will be served.

Amount of grant funding or fundraising match "up-to" (in dollars) requested OR type of support (i.e. meal donations, supplies for organization, fundraiser organization, volunteer help)* This field is required.

The IMPACT60 (i60) grant application is not intended to be a barrier to support. In order to stay true to our defined 501 (c) (3) purpose, both qualitative and quantative information must be submitted by the person/organization seeking assistance. Here are a few links that you can click to research grant terminology and to learn more about how to write your narrative or supporting information. Grant Glossary Grant Terms Grant Proposal Elements

Program/Project dataProvide your responses below.

Applicants must provide a Statement of Need. If applying for an organization, a narrative of the program/project description, a personnel list (who is helping) a timeline and budget outline must be included. If applying as an individual or on behalf of an individual or family in need, please include a narrative on the situation and why IMPACT60 is a good fit organization to provide support. You may type your statement in the box below or upload a document. Keep in mind that IMPACT60 has limited resources so focus your request on how the community or a person's quality of life can be improved. Additional information may be requested by IMPACT60. If you need an alternative way to provide this information, please email us: info@impact60.org

A Statement of Need can be typed below or you can upload the statement in the next box.

Upload your Statement of Need and any supporting documents here.

Drag and drop files here

Select files to upload

Please list below present sources of income (i.e. organization or individual/family) has available. * This field is required.In short, what money/support is available as far as you know? List all sources e.g. United Way, private donations, investment revenue, membership or program revenue, state or federal assistance, savings, checking, employment income, etc. The actual amount doesn't need to be included at this time. List each source on a separate line.

Required responses* This field is required.Check all that apply. You will provide full detail in a Statement of Need (below).

This help is requested for an individual and/or family.

This is for a need other than funding (e.g. reliable transportation, meals/food, shelter, volunteer help, property enhancements, care-giving, home goods, a referral for professional help)

This is a request to match fundraising dollars (up-to amount) decided by IMPACT60

This is a pilot program.

This program currently exists.

This grant request is a one-time request.

This is a project that hasn't been done before.

Evidenced-based practices have been used previously that apply to this program.

I will be collaborating with another person or organization.

Outcomes will be measured; results will be shared.

By submitting this application, I agree to provide IMPACT60, Inc. with program/project updates. I will submit a final outcome report and a copy of promotional materials at the conclusion of the program/project/or receiving help.* This field is required.IMPACT60, Inc. does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. We are committed to being inclusive and welcoming to all.

*INTERNAL USE*

approved

more information required

denied

IMPACT60, Inc. Grant Application

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