ROCHESTER AREA COMMON APPLICATION FORM

INFORMATION FOR GRANTSEEKERS & GRANTMAKERS

 

This form was developed in 1999 by the Rochester Grantmakers Forum and its Rochester Effectiveness Partnership to facilitate the application process for both grantmakers and grantseekers, and to focus on results. Grantmakers and grantseekers worked together to create it.

Before using the Common Application Form (CAF) please check the Guide to Grantmakers in the Rochester Area: 2002-2004 (The Guide) to see if your project or program matches the interest of the funder(s) you wish to contact. The Guide can be purchased from the Forum (585/232-2380) or used at many Monroe County public libraries. Some funders prefer a letter or phone call as the initial approach. Follow procedures for each funder as described in the Guide.

A printable version of the CAF can be downloaded at no charge from this site, click here.  A diskette with the CAF can be purchased from the Forum for $8. (Mail a check payable to the Rochester Grantmakers Forum to 919 Winton Road South, Rochester, NY 14618.)

The funders listed below have agreed to accept the Common Application Form. Where a dollar amount is included to the right of a name, provide items 1-10 described on the Application Content page when you are requesting that amount or more from the funder. You may omit items 3 and 4, the logic model and rationale, if your request is lower than the figure listed next to the funder’s name. If no figure is included following a name, that funder wants items 1-10 for requests of any size. In addition:

    (a) = Requires additional information 

    (b) = Requires letter of inquiry first 

    (c) = Call first

E.g.: ABC Foundation, $5,000, (c): Omit items 3 and 4 for requests below $5,000. Call before developing a proposal.

XYZ Corporation, $1,000, (a, b): Omit items 3 and 4 for requests below $1,000. Send letter of inquiry before developing proposal. Will request additional information on top of that requested in the Common Application Form.

The Smith Trust (b): Requires 1-10 for all proposals. Send letter of inquiry before developing proposal.

THE FOLLOWING WILL ACCEPT THE ROCHESTER AREA COMMON APPLICATION FORM

Advertising Council of Rochester (a, c; use short form for consultant, full form for community impact requests)

Agrilink Foods/Pro-Fac Foundation (use short form for all requests)

ALSTOM Signaling Foundation, $5,000

American Wildlife Research Foundation

Ames-Amzalak Memorial Trust, $1000

Bausch and Lomb, $5,000

Caldwell Manufacturing Company, $5,000

Chase Pitkin Home and Garden, $500 (a, b)

Citibank, $10,000

Cornyn Foundation, $1,000

Delphi Automotive Systems, $1,000

Eastman Kodak Company, $10,000 (a)

Everett Charitable Trust, $10,000

Foundation for the Jewish Community, $10,000

Goldberg Berbeco Foundation (a; use short form for projects with total budget under $10,000, full form for all others)

B. Thomas Golisano Foundation, $2,500 (a)

HSBC Bank USA – Rochester Region

Halcyon Hill Foundation, $5,000 (b)

HealthNow NY, (use short form for event underwriting under $1,000, full form for all other requests)

Daisy Marquis Jones Foundation, $6,000 (b)

Key Bank of New York, $10,000

Suzanne Lee Charitable Trust

Oliver B. Merlyn Foundation

Mary S. Mulligan Charitable Trust, $5,000

Park Ridge Foundation, $1,000 (b)

RCIPA Community Health and Educ. Fndtn., $1,000

Rochester Area Community Foundation:

Distributions Committee, $3,000 (b)

Feinbloom Supporting Foundation, $3,000 (b)

John F. Wegman Fund, (b; use full form for requests of $7,500 or more, and for any requests with total project budget of $15,000 or more)

Rochester Female Charitable Society

Rochester Primary Care Network (for pre-selected applicants only)

St. Mary’s Foundation, $1,000 (b)

Time Warner Communications, $1,000

Wegmans Food Markets, $1,000

Fred & Floy Willmott Foundation, $2,500 (proposal should be 1-sided and not bound or stapled)

M.C. and J.C. Wilson Foundation, $6,000 (b)

Women’s Foundation of the Genesee Valley

Wyman-Potter Foundation (use short form for all requests; additional information may be requested)

Xerox Corporation, $2,500

 

APPLICATION CONTENT

Please note: A. Applications should be legible. Handwritten in black ink, word processed or typed are all acceptable.

B. "Organization" = group whose 501(c)(3) status is being used.

Please include the following in a complete application, unless the funder has indicated that you may leave out items 3 and 4. (See previous page, Information for Grantseekers, for guidelines regarding when you may omit items 3 and 4, the logic model and rationale.)

  1. Executive Summary (This will take the place of a cover letter.) Please create in bulleted rather than narrative form. To save you time, we suggest that you wait until after completing the rest of the proposal to develop this section. We encourage you to limit this to one page or less. It should be a brief synopsis of your request, able to serve as a stand-alone piece for some.
    1. Organization name
    2. Project Definition
      1. Project/activity name
      2. One sentence summary of project/activity
    3. For this request, summarize:
      1. Why (community need)
      2. Who and how many (target population, including age, gender, ethnicity, other relevant characteristics)
      3. What (services provided)
      4. When (timeframe)
      5. Where (location of the work)
    4. What do you hope to accomplish (outcomes)?
    5. How does this request meet this funder’s priorities?
    6. State the total cost of this effort, and the amount requested from this funder.
    7. Signatures of CEO and a board representative, preferably the board chair or president.
      1. Information sheet (use attached form).
      2. Logic model (use attached form and instructions).
      3. Rationale (follow attached instructions).
      4. Program or Project Budget sheet (use attached form).
      5. Financial summary of your organization’s most recently completed fiscal year, including the original budget and actual revenue and expenses for that year.
      6. If you are a 501(c)(3) organization, a copy of the IRS determination letter advising that your organization is exempt from taxes under Section 501(c)(3) of the IRS code, and that the organization is not a private foundation as defined in Section 509(a).
      7. Listing of organization’s Board of Directors with their affiliations.
      8. Most recent audited financial statement and accompanying management letter for a complete fiscal year of the organization. If your financial statements have never been audited, indicate why – e.g. you are too small, or your organization is too new.
      9. Annual report, if available, or a brief description of the scope of your organization’s work.
  2. INFORMATION SHEET
  3. GRANT APPLICATION TO (name of funder):

     

    Organization Information

     

      Name & address of applicant organization:

       

       

      Is the name at the left the same as it appears on the IRS 501(c)(3) Letter of Determination? __yes __no

      If not, explain:

      Telephone Number:

      Fax Number:

      E-mail:

      For current fiscal year:

      Organization’s total budgeted revenue:

      Organization’s total budgeted expenses:

      Fiscal year: __________ to __________

      Chief Executive Name and Title:

       

      9-digit Federal Employer ID #:

      Year organization incorporated:

      Revenue Sources:

      ___ % government (city,county, state, federal)

      ___ % United Way

      ___ % membership

      ___ % fees

      ___ % grants

      ___ % investment income

      ___ % fund raising (e.g.

      events, gifts, bequests, etc.)

      Information for This Request

      Name of this program or project:

       

      Program/project contact person:

      Name:

      Phone #:

      Total cost of this effort:

      Amount requested from this funder:

       

      Type:

      __Capital

      __ Construction

      __ Renovation

      __ Equipment

      __Endowment

      __Program/Project

      __General Support

      __Other (describe)

       

      Date funds needed by:

      Date by which funds will be spent:

      List other potential and actual sources of support - put an "*" by those committed, noting any matching fund requirements.

      Amount         Funder

       

       

       

       

       

       

      List major funders of program/project for past two years if applicable:

      Amount         Funder

  4.  Rochester Area Logic Model

    (See Logic Model Packet guidelines and sample logic models.)

    Program/Project________________________ Agency____________________________ Date________________________

    Program/Project Time frame:______________________

    Program/Project Goal:________________________________________________________________________________________

    Names & titles of those with key roles in developing logic model:

    1. Inputs ($’s, staff, volunteers, materials & other resources required) Activities (What the program does with the inputs to achieve its outcomes) Projected Outcomes (Effects on knowledge, attitudes, skills, behavior, condition or status during or after the program/project)
      Quantify inputs wherever possible (e.g. "2.5 FTE social workers," "270 volunteer hours") Activities should be quantified (e.g. 2 support groups/10 moms ea./2 hrs/wk for 4 mos.) Shorter-term Outcomes 

      put a "*" next to those you will measure

      Longer-term Outcomes 

      put a "*" next to those you will measure

             

      (Add additional pages if needed.)

  5. RATIONALE

    1. (Please include the following. We strongly encourage you to limit the total length of the rationale to 4 pages or less.)

      1. Need/demand (present in bulleted format, and where possible, include local statistics, community priorities, etc)
          1. Summarize the need for your planned work.
          2. Summarize customer demand for this work.
      2. Outcomes
        1. For each outcome you will track, as identified in your logic model, indicate how you will know if you succeed in achieving it, using the following format.

           

          Outcomes

          Indicators/Measures (What will you measure to know if you reach your outcomes?)

          Targets/Performance Standards/Projected levels of success/What will tell you that you have achieved your outcomes?

          By when will targets be achieved?

           

               

           

      3. Activities (use bullets or a chart where possible)
        1. Why do you believe the activities listed in your logic model reduce or eliminate the need described in item A on this page?

      4. Organizational capacity to undertake project
          1. What is your organization’s mission, and how does this project relate to it?
          2. Summarize similar program accomplishments in the past, including the extent to which your outcomes were reached (use bullets or a chart where possible).
      5. Links with other agencies
          1. If this is a collaborative effort, complete the following:
          2.  

            Collaborating organizations

            Contact person

            Phone number

            Role(s) of partners

             

                 

          3. Do you know of other groups doing similar or related work? If so, how does your work differ from or complement theirs?
      6. What is the future of the program or project beyond  the grant period?
          1. In terms of programming, summarize what is envisioned.
          2. If it is to continue beyond the grant period, how will you support this project?
      7. In no more than ½ page, say anything else you want to about this request.

 

5. PROGRAM OR PROJECT BUDGET SHEET

A. Provide the following information regarding the program or project for which you seek funds.

 

SUPPORT/REVENUE

 

Total Anticipated Support/Revenue

1. Requested grant

 

2. Fundraising events

 

3. Gifts/bequests

 

4. Miscellaneous contributions

 

5. Foundation/corporate grant support

 

6. United Way

 

7. Grants/contracts: govt. agencies

 

8. Program service fees

 

9. Membership dues

 

10. Investment income/transactions

 

11. Sales: services, products, crafts

 

12. Miscellaneous revenue

 

13. Subtotal Direct Support/Revenue

 

*14. Proration: General & Management Income

 

15. Total Support/Revenue

 

*General organizational funds/income that are applied to this program/project, eg. endowment earnings, general contributions.

EXPENSES

 

Total Expenses

Expenses Covered By Requested Grant

16. Salaries of provider staff

   

17. Fringe benefits

   

18. Professional fees (contract, consultant)

   

19. Supplies (consumable)

   

20. Printing and postage

   

21. Occupancy

   

22. Phone and fax

   

23. Travel and meetings

   

24. Training

   

25. Evaluation

   

26. Equipment purchases

   

27. Miscellaneous expenses

   

28. Subtotal Direct Expenses

   

**29. Proration: General & Management Expenses

   

30. Total Expenses

   

31. Surplus (Deficit)

 

** Administrative staff and/or other general organizational expenses applied to this program/project.

B. If you feel elements of your budget need explaining, please do so in no more than ½ page.

 

 

Rochester Grantmakers Forum
919 Winton Road South, Rochester, NY 14618
ph. 585/232-2380,  fax. 585/232-8413, email. rgf@frontiernet.net
Copyright © 2000 by Rochester Grantmakers Forum. All rights reserved. Policies & Disclaimers.
Revised: 02 Mar 2004 14:02:34