Application File 2017

Dana Home Foundation Grant Application Form

Use this page to submit the Grant Application in .pdf format.

* Indicates required field

Name of organization *

Primary contact name *

Primary contact telephone *

Program name *

Primary contact email address *

Grant Cover Letter and Financials *

Max file size: 20MB

Grant Amount Requested *

Total Budget for Program *

Submit

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Grant Amount Requested
Total Budget for Program
Brief Summary of Program
Does organization have IRS 501(c)(3) status? (if so, skip to question 8)
Is applicant a municipal or other US governmental entity intending to use the funds solely for charitable purposes?
Were previous grants received from The Dana Home Foundation within the last five years?
Describe anticipated program timeline including anticipated program starting date and program completion date, if applicable
Provide a detailed one-page summary of the proposed program’s total budget that includes:
a. An itemized list of projected expenses; and
b. All sources of funding for this program (and the amount anticipated from each source).
If you anticipate this program continuing beyond this grant year, please specify how you plan to continue funding the program.
Describe program funding and success in previous years. (If this is a new program, state so.)
State program goals and objectives and describe your plan to meet these goals and objectives.
Describe your plan to measure your achievement of program goals.
Describe the target audience of the program.
Provide anticipated number of seniors served by program and describe the seniors’ connection to Lexington.
List any other organizations/departments you are collaborating with to accomplish the program.
Describe any additional approvals needed for program.