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2014 Dana Home Foundation Grant Application
Form Part II
You may complete Part II of the Dana Home Foundation Grant Application on this on this page by typing your answers in the boxes in this online form.
(If you prefer to complete Part II of this application by uploading a document click on link for
Part II Application File Upload page
.
)
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Indicates required field
Name of Organization
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Name of organization from question 2.
Primary contact name
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Contact person from question 22 who can answer questions about this application.
Primary contact telephone
*
Program Name
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Program Name from question 19.
Primary contact email address
*
33. State program goals and objectives
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In 500 words or fewer, describe the goals and objectives of your program.
35. Describe anticipated program timeline
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What is the anticipated timeline for the program?
37. Describe program target audience
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Who is the target audience of the program?
39. Provide description of any additional approval needed for program
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If the applicant is a municipal or other US governmental entity, please detail any additional approval or support needed from any other government departments or agencies in order to proceed with the proposed program. If no approval needed, state none needed.
34. Describe your plan to meet program goals and objectives
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In 500 words or fewer, how do you intend to meet the goals and objectives of your program?
36. Describe plan to measure achievement of program goals
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Describe how you will measure your progress towards and success in meeting the program goals.
38. Provide anticipated number of seniors served by program and describe their connection to Lexington
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40. Total amount needed to fund program including itemized list with detailed descriptions of projected expenses.
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List the total resources needed to fund this program.
41. List any organizations collaborating with this program
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List any other organizations/departments you are collaborating with to accomplish the program. If none, write none.
42. List additional sources of funding for program
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List any other sources of funding for this program. If none, state none.
43. Describe funding plan for multi-year programs
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If you anticipate this program continuing beyond the grant year, please specify how you plan to continue funding the program. If this program is not expected to continue beyond this year, state this.
44. Describe program funding and success in previous years
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If this is not a new program, please describe previous sources of funding and your initial goals indicating whether they were met. If this is a new program, state so.
Name of person signing below
*
Signature
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Accept
Title of person signing below
*
By checking this box you acknowledge that the foregoing information is accurate to the best of your knowledge and that you are authorized to submit this application on behalf of the organization.
Submit
If you have questions about this online form or experience difficulty submitting the form, please email
WebSupport@DanaHomeFoundation.org
.
