The Irene E. & George A. Davis Foundation Grant Application

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Organization and Contact Information

Application Type

Account ID

Organization Information

Applicant Organization (Legal Name)

Federal Tax ID

Copy of IRS Determination Letter

Organization Contact Information

Address Line 1

Address Line 2

City

State

Postal Code

Phone

Website Address

Requestor Contact Information

Prefix

First Name

Last Name

Suffix

Title

Phone

Email

Executive Director Contact Information

I am the Executive Director

First Name

Last Name

Email

Phone

Description of the Organization and its Mission

Please provide a brief description of the organization, population served, and mission.

Organization Leadership

Please provide a list of your senior staff leadership team including name, title, and tenure.

Please provide a list of your current Board of Directors including name, affiliation, and tenure.

Funding Request Information

Funding Request Details

Funding Request Name

Please enter max 80 characters.

Amount Requested

Please enter a whole number with two decimals max, no dollar signs or separating commas, e.g. 1000.55.

Is this funding request for a one-year grant or a multi-year grant?

The Irene E. & George A. Davis Foundation awards funding in the following areas:

Priority Impact Issue Areas

- Early Childhood

- Early Literacy

- K-16 Education

- Youth Development

- Economic Development

Community Support

- In addition to focusing on the funding priorities mentioned above, the Foundation also considers requests from organizations for projects/programs that may not fall into one of the above categories, but that still offer a vital service to or enriches the lives of Hampden County residents. These grants are typically $25,000 or less.

Based on the categories listed above and your request, please select the funding area below that you feel best aligns with the work that your organization does and/or the program/project for which you are seeking funding. If there is alignment with more than one funding area, please select a single funding area that best aligns.

Does your project serve or impact residents of Hampden County?

Please indicate which cities/towns your project impacts. Please check all that apply.

To select more than one value, hold down the ctrl key and highlight the desirable values.

Funding Request Description

Please provide a brief description/summary of the project or program for which you are requesting funding.

If you are a returning applicant and requesting funding for the same program, please also share: (1) how the program went in the most recent grant period, (2) who you served, and (3) key outcomes or lessons learned.

Please provide a description of the population you aim to serve or reach through this proposed project/program, including the number of individuals you intend to serve:

What is the total cost for this specific program/project? Please provide a budget specific to the proposed work related to Hampden County.

Please enter a whole number with two decimals max, no dollar signs or separating commas, e.g. 1000.55.

Are there any organizations/entities that you are working with/collaborating with to deliver this program/project? If so, please indicate the names of these organizations and provide a brief explanation of how are you working together:

Please provide detail with respect to program goals and desired impact:

What are your primary goals and/or what do you hope to achieve?

How do you intend to measure your progress or success?

If available, please share any data that you have that provides evidence of the impact of your program. (Examples might include data, evaluation results, participant feedback, testimonials, or other indicators of impact)

If available, please share any data that you have that provides evidence of the impact of your program.

Up to 3 files only.

Additional Funders

Please list other funders from whom you have requested funding for this project. Sharing this is not a requirement but does help us understand how you intend/hope to fully fund this program/project.

Click Add another response for each entry (up to 5).

Funder Name

Amount of Funding

Please enter a whole number with two decimals max, no dollar signs or separating commas, e.g. 1000.55.

Funding Status

Organization Financials

Organization Total Budget

Please enter a whole number with two decimals max, no dollar signs or separating commas, e.g. 1000.55.

Organization’s most recent 990

The most recent 3 years of audited or reviewed financial statements.

Up to 5 files only.

Current fiscal year budget.

Please provide a list of your organization's top five funding sources (foundations, government grants/contracts, individuals, etc.), with annual contribution amounts, for past three years.

Certification

Please initial below to indicate that this grant application is being submitted with the full knowledge of your organization's Executive Director

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