Fund for Omaha

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Fund for Omaha's Greatest Need Grants Program Application Cover Page

Application Date *

Federal Tax ID # *

Organization Type *

Agency Focus *

Use this space to provide information for your organization. Please use regular capitalization (not all capital letters).

Organization Name *

Name of Executive Director/CEO *

Primary Contact Salutation * This is who we will contact if there are any questions about this proposal.

Primary Contact First Name *

Primary Contact Last Name *

Primary Contact Suffix

Primary Contact Title *

Mailing Street *

Mailing City *

Mailing State/Province * Use 2-letter abbreviation (such as NE)

Mailing Zip/Postal Code *

Phone *

Fax

Email *

Website

Use this space to provide information if you marked "not a 501(c)(3)" and are applying for funds through a fiscal agent.

Fiscal Agent Name

Fiscal Agent Contact Person

Fiscal Agent Contact Person Title

Fiscal Agent Mailing Address

Fiscal Agent Phone

Fiscal Agent Email

Fiscal Agent Fax

Fiscal Agent Website

Fiscal Agent ED/CEO

Typed Signature of Fiscal Agent

Choose the category of your Greatest Need: *

If program expense, choose program focus:

Please give no more than a two-sentence summary of request (no more than 500 characters and spaces): *

Dollar Amount Requested * For this and all other dollar amounts, type whole numbers only (5000, for example, not 5,000 or 5000.00). Do not include dollar signs ($).

Total Project Cost *

What was the last Fund for Omaha grant your agency received?

Last Grant Amount

Last Grant Date

Last Grant Purpose

I have read the guidelines for this Fund for Omaha Grant Application and the Fact Sheet for the funder to which I am submitting this request. I understand that not all funders use this format.

Typed Signature *

Date of Signature *

Fund for Omaha's Greatest Need Grants Application

Keep your response to each question to no more than 1000 characters and spaces.

Organizational Description *

Description of Greatest Need: Include why this is your agency's top priority at this time. *

Strategies: What actions will you take to go about addressing your Greatest Need? *

Expected Results: How would the fulfillment of your Greatest Need affect your agency, the people it serves, and our community? *

Evaluation: How will you know if the Greatest Need is met successfully? *

Sustainability: Is this a one-time or ongoing Need? If ongoing, how will you continue to address it in the future beyond the grant period? *

Similar Organizations or Programs: List some other organizations that offer similar services. Discuss how services are coordinated and if any gaps remain. *

How many clients does your organization serve in a year? *

How many clients would this grant serve?

For the following questions, consider the populations your organization currently serves.

Please enter what percentage of your clients are in each of the following identity groups:

African American Clients *

Asian American Clients *

Caucasian Clients *

Latino/Latina Clients *

Native American Clients *

Asian Clients *

African Clients *

Other Client Type

Other Client (Percentage) *

Total Clients (this will add up automatically from the values above and must equal 100%)

Check all of the populations that your organization currently serves (choose all that apply) * Hold down the "Ctrl" key to select more than one.

Check your organization’s geographic areas of service (choose all that apply) * Hold down the "Ctrl" key to select more than one.

2. Financial Information. Please use the budget templates below.

Income: Current Fiscal Year Ending *

Govt Grants/Contracts Org *

Govt Grants/Contracts Greatest Need *

Pending Foundation Requests Org *

Pending Foundation Reqs Greatest Need *

Please specify amounts and funders of pending requests

Confirmed Foundation Requests Org *

Confirmed Foundation Reqs Greatest Need *

Please specify amounts and funders of confirmed requests

Corporations Org *

Corporations Greatest Need *

United Way/Federal Org *

United Way/Federal Greatest Need *

Individual Contributions Org *

Individual Contributions Greatest Need *

Membership/Fee Income Org *

Membership/Fee Income Greatest Need *

Investment Income Org *

Investment Income Greatest Need *

In-Kind Income Org *

In-Kind Income Greatest Need *

Other Income Org *

Other Income Greatest Need *

Other Income Org (Please Specify):

Other Income Greatest Need (Please specify):

Total Income Organization

Total Income Greatest Need

Expenses (Current Fiscal Year)

Salaries/Wages Org *

Salaries/Wages Greatest Need *

Insurance/Benefits/Taxes Org *

Insurance/Benefits/Taxes Greatest Need *

Consultants/Professional Fees Org *

Consultants/Prof Fees Greatest Need *

Travel Org *

Travel Greatest Need *

Equipment Org *

Equipment Greatest Need *

Supplies Org *

Supplies Greatest Need *

Printing/Copying Org *

Printing/Copying Greatest Need *

Telephone/Internet Org *

Telephone/Internet Greatest Need *

Postage Org *

Postage Greatest Need *

Rent/Utilities Org *

Rent/Utilities Greatest Need *

Depreciation Org *

Depreciation Greatest Need *

In-Kind Expense Org *

In-Kind Expense Greatest Need *

Other Expense Org *

Other Expense Greatest Need *

Other Expense Org (Please specify):

Other Expense Greatest Need (Please Specify):

Total Expenses Organization

Total Expenses Greatest Need

Current Board Members: Please list name; officer role served on your board, if any; and professional affiliation (employer and title). *

After you press the "Submit" button below, you will have a chance to review your complete application, go back and make changes, and print a copy for your records. You must then press the "Confirm" button (at the bottom of the next page) to complete your submission, and you will receive a confirmation email after it is submitted successfully.

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