Brotherhood Sample Grant App by 62ppN2T

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									                                Mitchell Kapor Foundation
                                College Bound Brotherhood
                                 Sample Grant Application

This is an example of the application questions with which you will be presented. It is
recommended that you compose the answers to the paragraph questions in a word processing
program and then cut and paste that text into the online application..

                                     Contact Information

*First Name                                     Instructions:
(Text; 40 character maximum)                     Please enter your first name.

*Last Name                                      Instructions:
(Text; 40 character maximum)                     Please enter your last name.

*Telephone                                      Instructions:
(Text; 30 character maximum)                     Please enter your telephone number.

*E-mail Address                                 Instructions:
(Text; 100 character maximum)                    Please enter your e-mail address.

                                                Instructions:
*Executive Director?
                                                 Are you the Executive Director? If so, skip
(Yes/No)
                                                the next few questions.

Executive Director First Name                   Instructions:
(Text; 40 character maximum)                    

Executive Director Last Name                    Instructions:
(Text; 40 character maximum)                    

                                                Instructions:
*Backup Contact Person Full Name
                                                 Due to staff turnover, we would like a backup
(Text; 100 character maximum)
                                                contact for your organization.

*Backup Contact Person Email                    Instructions:
(Text; 100 character maximum)                   

                                   Organization Information

*Legal Name                                     Instructions:
(Text; 100 character maximum)                    Please enter your organization's legal name.

*Address                                        Instructions:
(Text; 100 character maximum)                    Please enter your organization's address.

*City                                           Instructions:
(Text; 50 character maximum)                     Please enter your organization's city.

*State
                                                Instructions:
(Single-Select List)
                                                 Please enter your organization's state.

*Zip                                            Instructions:
(Text; 20 character maximum)                        Please enter your organization's zip code.

                                                   Instructions:
*Telephone
                                                    Please enter your organization's telephone
(Text; 30 character maximum)
                                                   number.

Website Address                                    Instructions:
(Text; 100 character maximum)                       Please enter your organization's web address.

*Mission Statement                                 Instructions:
(Paragraph; 2000 character maximum)                 Enter your organization's Mission Statement.

*Organization's Annual Budget                      Instructions:
(Number; 15 digit maximum)                         

                                                   Instructions:
Fiscal Sponsor Name (if applicable)
                                                    Enter the full name of your organization's
(Text; 255 character maximum)
                                                   fiscal sponsor.

                                                   Instructions:
Fiscal Sponsor Address (if applicable)
                                                    Enter the address of your organization's fiscal
(Text; 255 character maximum)
                                                   sponsor.

Fiscal Sponsor City (if applicable)                Instructions:
(Text; 255 character maximum)                      

Fiscal Sponsor State (if applicable)               Instructions:
(Text; 255 character maximum)                      

Fiscal Sponsor Zip (if applicable)                 Instructions:
(Text; 255 character maximum)                      

Fiscal Sponsor Contact First Name                  Instructions:
(Text; 255 character maximum)                      

Fiscal Sponsor Contact Last Name                   Instructions:
(Text; 500 character maximum)                      

Fiscal Sponsor Contact Email                       Instructions:
(Text; 255 character maximum)                      

                                         Request information

                                                   Instructions:
*Grant Period Start Date
                                                    Please enter the date which you want to start
(Date)
                                                   using this grant.

                                                   Instructions:
*Grant Period End Date
                                                    Please enter the date which you want to stop
(Date)
                                                   using this grant.

*Type of Support Requested
                                                   Instructions:
(Single-Select List)
                                                    Please pick the most appropriate.
 Capacity Building
 General Support
 Project Specific

                                                 Instructions:
*Requested Cash Amount
                                                  Please enter the amount you are requesting
(Currency; 20 character maximum)
                                                 for this project.

Grant Amount                                     Instructions:
(Currency; 20 character maximum)                 

                                                 Instructions:
                                                  All College Bound Brotherhood applicants
*College Bound Brotherhood Database              are required to complete a profile for their
(Yes/No)                                         organization in the College Bound Brotherhood
                                                 Database at collegeboundbros.org. Was a
                                                 profile completed for your organization?

                                                 Instructions:
*College Bound Program Summary                    Please briefly summarize your program's
(Paragraph; 1500 character maximum)              work. How will this increase the number of
                                                 young black men who are prepared for college?

                                                 Instructions:
                                                  Why does your organization feel it is
                                                 important to increase the number of African
*College Bound Movement
                                                 American males who graduate high school and
(Paragraph; 2000 character maximum)
                                                 go on to college? What is your organization
                                                 doing to build a movement around this body of
                                                 work?

*What measures has your organization taken to
strengthen its efforts to address the needs of
                                                 Instructions:
African American males (e.g. conferences,
                                                 
professional development, workshops)?
(Paragraph; 2000 character maximum)

                                                 Instructions:
*College Bound Partnerships                       How did your organization partner with other
(Paragraph; 2000 character maximum)              college access organizations last year? Which
                                                 organizations did you partner with?

                                                 Instructions:
*Technology                                       How does your organization use technology
(Paragraph; 2000 character maximum)              and social media to advance your outreach and
                                                 education efforts?

*How will you determine if your organization's
                                                 Instructions:
work is successful?
                                                 
(Paragraph; 2000 character maximum)

*List your organization's board officers and
                                                 Instructions:
members.
                                                 
(Paragraph; 500 character maximum)

*List this program's/project's relevant staff    Instructions:
members with job titles.                         
(Paragraph; 2000 character maximum)

*Brotherhood Events
(Multi-Select List)
 Brotherhood Graduation Celebration - June
2011
 Back to School, Back to Work: College          Instructions:
Readiness Convening for Practitioners -           Which of the following Brotherhood events
October 2011                                     did you/your students attend this past cycle?
 Black & Proud to Be College Bound              (Select all that apply)
Conference 2.0 - March 2012
 Brotherhood Graduation Celebration - June
2012
 I/we did not attend any events.

                                         Demographics

*Please indicate the primary geographic focus
of your work.
(Checkbox List)
 Alameda
 Contra Costa
 Marin
 Napa
                                                 Instructions:
 San Francisco
                                                  Check all areas that apply
 San Mateo
 Santa Clara
 Solano
 Sonoma
 CA Statewide
 National
 Other US Local/Regional

*How many students will the work described in
                                                 Instructions:
this application directly impact?
                                                 
(Number; 15 digit maximum)

*How many black male students will the work
                                                 Instructions:
described in this application directly impact?
                                                 
(Number; 15 digit maximum)

                                                 Instructions:
*Current black males
                                                  How many black males are you currently
(Number; 15 digit maximum)
                                                 working with?

Race and Ethnicity
(Percentage List)
                                                 Instructions:
 Caucasian
                                                  Please indicate by percentage the projected
 African American/Black
                                                 makeup of constituencies/students served by
 Pacific Islander
                                                 this project:
 Native American
 Asian
 Hispanic/Latino(NonWhite)
 Mixed Heritage
 Other

*Please indicate if your organization fits any of
the following categories:
(Checkbox List)
 At least 50% of Board comprised of people         Instructions:
of color                                             For our purposes, people of color are those
 At least 50% of staff comprised of people of      who identify as African American/Black,
color                                               Asian/Pacific Islander, Hispanic/Latino, Native
 Executive Director or CEO is a person of          American, or Mixed Heritage. (Check all that
color                                               apply)
 This grant request focuses on communities of
color
 None of the above

*How does your organization ensure
appropriate diverse representation (i.e. through
                                                    Instructions:
board and staff composition, programming,
                                                    
outreach, etc.)?
(Paragraph; 2000 character maximum)

                                      Organization Financials

*How would you describe your organization's
current and ongoing stability (i.e. staff           Instructions:
retention, financial resources, etc.)?              
(Paragraph; 2000 character maximum)

                                                    Instructions:
                                                     a) your organization's itemized operating
*Please provide (in one spreadsheet or
                                                    budget, and b) the itemized program/project
document if possible):
                                                    budget, which should include the amount
(File Upload; 524,288 byte limit)
                                                    requested from the Kapor Foundation and how
                                                    those funds will be used.

                             Fiscal Sponsor Supplemental Information

                                                    Instructions:
                                                     1. A copy of any fiscal sponsorship
                                                    agreement/contract between your organization
                                                    and the fiscal sponsor and/or a letter indicating
For organizations with a fiscal sponsor, please
                                                    that your fiscal sponsor accepts full legal, fiscal
also provide:
                                                    and programmatic responsibility for the grant.
(File Upload; 2,621,440 byte limit)
                                                    2. The fiscal sponsor’s most recent, completed
                                                    full year organizational financial statement
                                                    (expenses, revenue and balance sheet), audited,
                                                    if available.

								
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