The Rohm and Haas Community Partnership Initiative

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					                    The Dow Chemical Company DowGives Program
                                Grant Application


I.    Overview of the Grant Program: Dow’s goal, using the DowGives grants, is to
      enhance the aesthetic qualities of our fenceline neighborhoods and positively impact the
      overall quality of life in the Knoxville community by providing a grant of $30,000 to the
      non-profit organization best able to advance its focus on community land use projects.
      Priority consideration will be given to specific programs or projects that:
            Involve beautification, greenways, parks, neighborhood cleanup, neighborhood
              involvement and community pride, historical preservation and environmental
              improvement.
            Are within a three-mile radius of The Dow Chemical Company Knoxville
              operations
            Address a demonstrated need within our area of focus
            Have a clear and measurable plan for achieving a long-term impact
            Are sustainable after the conclusion of the DowGives grant
      It is Dow’s preference to provide one $30,000 grant to a single sustainable program or
      project. However, if circumstances or conditions arise that prevent this from occurring,
      up to two grants ranging from $10,000 to $20,000, but not exceeding a total of $30,000,
      will be considered for two organizations.


II.   Directions for Completing Your Application: The information you provide on this
      application should help us understand how your program or project will impact the grant
      program’s focus and priorities. Application are available on-line at
      http://www.rohmhaas.com/wcm/about_us/locations/knoxville/responsible_neighbor.page
      ?tab-id=1


      1. Before submitting your application, please use the “Quick Test for Eligibility”
         below to be sure your organization qualifies for consideration. Also, if you have won
         the grant within the last 3 years, you are not eligible to apply again.

      2. When you complete your application, submit your application via mail or hand
         deliver to:
         The Dow Chemical Company
         Attention: Gail Benner
         730 Dale Avenue
         Knoxville, TN 37921

      3. Along with your application, please include a copy of your IRS 501(c)(3) tax
         exemption determination letter. You may also attach copies of brochures, annual
   reports and other material that you think would be helpful in considering your
   request.

4. Send by the deadline! Your application must be received no later than 5:00 P.M.,
   September 24, 2010 to be eligible for consideration
III.   Quick Test for Eligibility
Before completing this application, please complete the Quick Test for Eligibility to be sure
your organization qualifies.

A. To be considered eligible for a grant from DowGives you must be able to answer “Yes” to
   the following questions:
1. Your Tax Status is a qualifying tax-exempt organization or you have partnered with a
   qualifying tax-exempt organization that has agreed to serve as your fiscal agent on the
   DowGives grant.
   Yes ___ No ___
2. Project or program delivers service to the people, land or properties within the three-mile
   radius of The Dow Chemical Knoxville Site. Yes ___ No ___
3. Project or program focuses on Community Land Use. Yes ___ No ___
4. Funds from the grant will be utilized within one year of disbursement. Yes ___ No ___

If you have answered “No” to any of the above questions you are not eligible for a grant from
the DowGives program.

B. To be considered eligible for a grant from the DowGives program you must be able to
    answer “No” to the following questions:
1. Veterans organization? Yes___ No ___
2. Religious Organization? (Except projects or programs that are non-secular and are offered
    to the entire community on a non-sectarian basis) Yes ___ No ___
3. Labor organization? Yes ___ No ___
4. Fraternal organization? Yes ___ No ___
5. Organization requesting goodwill advertising? Yes ___ No ___
6. Endowment Fund? Yes ___ No ___
7. National Organization? Yes ___ No ___
8. Individual? Yes ___ No ___
9. Political Party or Candidate for Public Office? Yes ___ No ___
10. Funds will be used for a one-time or short-term special event? Yes ___ No ___
11. Scholarship Support? Yes ___ No ___
12. United Way Agency? Yes ___ No ___

If you have answered “Yes” to any of the above questions you are not eligible for a grant from
DowGives. Also, please contact Gail and she will have your organization removed from the
mailing list.


IV.    Grant Application Information
A. Organization Information: Please tell us about your organization. [Please note
   collaboration between two or more organizations is encouraged if it will result in a program
   that creates an even stronger impact on the grant’s focus.]


1.   Date: ___________________
2.   Name of Organization: ______________________________________________________
3.   Contact Name/Title: ________________________________________________________
4.   Phone: _____________________ Fax: ______________________
5.   E-mail (required): ________________________________________
6.   Address:
     ___________________________________________________________________________
     ___________________________________________________________________________
     ___________________________________________________________________________

7. Purpose/Mission of Organization:
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

8. Brief History of Organization:
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

9. Geographic area/population/demographic served by the organization:
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

10. Number of people served each year:
    ______________________________________________
B. Proposal Information: Please describe the specific program or project that you would like
   the DowGives grant to support.

1. Title of the project or program for which the grant is requested:
   ___________________________________________________________________________

2. Is the proposed project or program in any way a duplication of any other current or
   proposed project or program? Yes ___ No ___
   If you answered “Yes” please explain:
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

3. Name and title of the person who will be responsible for managing the proposed project
   or program:
   __________________________________________________________________

4. What geographic community will benefit from the proposed project or program?
   ___________________________________________________________________________
   ___________________________________________________________________________

5. Why is the project or program needed? Please keep in mind the grant’s focus on
   Community Land Use and target of the fenceline neighborhoods of the Dow Chemical Site.
   Also please include any photos or sketches, if available.
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

6. What is the objective and purpose of the project or program and the expected results?
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ________________________________________________________________________

7. What is the timetable for implementing the project or program? (Please note that the
   funds from the grant must be used within one year of the disbursement of funds.)
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

8. Describe the long-term impact of the project or program:
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ________________________________________________________________________

9. How will the project or program be sustained after the funds from the grant are
   depleted?
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ________________________________________________________________________

10. How will you measure the results of the project or program and how will you illustrate
    those results to Dow Chemical?
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ________________________________________________________________________

11. What is the grant amount that you are requesting from DowGives?
    $____________________________________________________________________
    Projects or Programs requiring a grant of $30,000 will be given priority consideration.
    Proposals for grants between $10,000 and $20,000 will also be considered but will not be
    given priority consideration in this category.

12. Budget Allocations:

 Type                                    Amount   De scription


 Ad mi ni strati ve/Gen eral

 Proj ect/Program Co sts

 Staff

 Eq uip ment/Sup pl ie s/Facil i ti es

 Fu nd Rai sin g

 Pu bli city

 Other

 Tota l
13. What other sources of funds are supporting or being solicited to support the project or
    program? Please include type of support and amount.

 Sourc e of Funds           Type of Support         Committe d or         Amount
                                                    Solicite d Support?




C. Application Submission Requirements:
When submitting your application, please note the following requirements and complete the
following checklist:
 Include 9 completed copies of your application
 Body of the application is no more than four pages (not including supplemental
    requirements)
 Include a single copy of your organization’s or your partnering organization’s Tax
    Exemption Ruling or Determination. If you are partnering with a tax exempt organization,
    then you must also include a letter of intent from that organization.
 Include a current audited financial statement
 Include a membership list of your Board of Directors
 Include a single copy of any brochures, annual reports and other materials that you think
    would be helpful in considering your request

D. 2010 Timetable for Proposal Evaluation
1. September 24: Grant Application Deadline (We will review all proposals for completeness.
   If there are questions, concerns or missing information, we will contact you giving you an
   opportunity to revise and resubmit your proposal.)
2. Mid-October: Final Proposal Evaluation: The DowGives Committee will review all
   proposals and select 1-3 finalists to conduct a site visit.
3. Late November: Grant Decision – The Dow Knoxville Community Advisory Council will
   select the 2010 grant recipient.
To be considered, this application must be signed by your organization’s Chief Executive. By
signing the application, the Chief Executive is approving the application and certifying that the
information contained in the application is accurate to the best of his/her knowledge.



Signature and Title of Chief Executive

V.     Questions?
Please call Gail Benner, The Dow Chemical Company, at 865.521.8435, if you have any
questions regarding The Dow Chemical Company DowGives program. Your completed
application should be sent or delivered to:

The Dow Chemical Company
Attention: Gail Benner
730 Dale Avenue
Knoxville, TN 37921

If you are hand delivering your package to the above address, please drop it off at Gate 1
and the guards will deliver it to Gail.

				
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