Union Labor Health Foundation - COMMUNITY HEALTH GRANT APPLICATION

COMMUNITY HEALTH GRANT APPLICATION

If you plan to apply for a grant in excess of $10,000, please contact Laura Olson, Executive Director, 707-442-2417 .

Deadlines:
September 1 and March 1 (postmarked or delivered).
Notification of results within 2 months.

2 Ways To Apply:

Easy Online Application Below
By Postal Mail - Download Guidelines and Application: In Word| In PDF

About Your Organization
Agency Name:		Contact Name:
Address:		City:
State:		Zip:
Title:		Contact Phone:
Email:		Fax:
Number of Employees:		Number of Volunteers:
Total income last fiscal year:		Expected total income this fiscal year:
Executive Director:		Director's Phone:
About Your Project
Title of Project:		Location of Project (city, community, area):
One sentence description of project:
Amount requested:		Total cost of project:
Who will benefit from this project (youth, seniors, disabled, etc.):
Please attach no more than 7 pages with information requested in the following items 1 through 5. 1. Description of the project, including all of the following: need for the project, expected outcomes, who and how many will benefit from the project, staff�s and/or volunteer�s qualifications to make the project a success, timeline, how results will be evaluated and how you will use the information, how the program will be sustained or will make a lasting impact in the community, community partners; relation of this project to other programs or projects in the community. Up to 3 letters of support may be included (in addition to the 7 page maximum). 2. Project budget showing total project costs and costs covered by this request (how grant funds will be spent). 3. Brief description of your organization and scope of programs, include who and how many you serve. 4. Summary of the organization�s financial statement from your last fiscal year and your current budget. 5. List of your current Board of Directors showing city of residence and occupation. Attach File Below: Allowed extensions: gif,jpg,doc,txt,eps,exe,cvs,html,xml Maximum Filesize: 524288 bytes Please attach the following tax documents: 6. Letter of tax exemption from the IRS (501(c)3) letter). Attach Files Below: Allowed extensions: gif,jpg,doc,txt,eps,exe,cvs,html,xml Maximum Filesize: 524288 bytes
Agreement to Grant Terms By subitting this application form, the applicant enters into an agreement with the Union Labor Health Foundation, supporting organization of the Humboldt Area Foundation, that would take effect should the grant be awarded. The applicant agrees to the Grant Terms(need to add link here) >
Accepted on behalf of:		Organziation Name:
By (Name):		Title:
Agree Disagree

= Required

Guidelines for submitting application by Postal Mail:

1. Submit:

Grant Application Form (12 copies),
Attachments (See Application Form) - seven pages maximum – (12 copies),
- Project Description, including:
  - Need for the project,
- - Expected outcomes,
  - Who and how many will benefit,
  - Staff and/or volunteer qualifications,
  - Timeline,
  - How results will be evaluated,
  - Community partners,
  - Relation of this project to other programs or projects,
  - Up to 3 letters of support (in addition to the 7 page maximum)

- Project Budget,
- Description of Organization,
- Organization’s Financial Statement Summary and Operating Budget,
- Board of Director’s List.
One copy of the applicant organization’s letter of tax exemption (501(c)3 letter),
One original signed Agreement to Grant Terms (keep a copy for your records).

2. Postmark or deliver by 5 pm on day of the deadline to:

Union Labor Health Foundation
373 Indianola Road
Bayside, CA 95524

NOTE: If the deadline falls on a weekend or holiday, the deadline will be the following working day.

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