Nonprofit Repositioning Fund Transition Grant Application
Organizational Overview
Organization Name and Address
Legal Name of Organization
EIN
Street Address
City
State
Zip Code
Contact Information
Primary Application Contact Name
Primary Application Contact Title
Primary Application Contact Email Address
Executive Director/CEO Name
Executive Director/CEO Email Address
Executive Director/CEO Phone Number
Board Chair Name
Board Chair Email Address
Organizational Information
Organization's Mission
Organization's Key Programs and Services
County(ies) Served
Bucks
Chester
Delaware
Montgomery
Philadelphia
Current Fiscal Year Operating Budget ($)
Current Full Time Employees or Equivalent (FTE) (#)
Financial Information
Please briefly describe funding loss(es). Include source(s), date(s) of notification of loss of funding, amount(s), and whether temporary or permanent to the best of your knowledge.
Please upload any evidence of funding losses (e.g., notification letters), if available.
What is the organization's runway estimate (cash on hand divided by monthly expenses) assuming no new revenue?
Please select...
Less than one month
1-3 months
3-6 months
6 months or more
Does the organization have any outstanding debt and/or lines of credit? If so, please provide details (creditor(s), amount(s), maturity date(s))?
Does the organization hold any assets that will require a specific plan for transfer, stewardship, or disposal as part of this organizational transition?
Yes
No
If so, what assets?
Real estate (owned)
Long-term lease
Equipment or physical property
Archives/collections/artifacts
Client data or records
Organizational data or records
Intellectual property
Restricted funds, investments, and/or endowments
Other
Please upload the organization's most recent audit or board-level financial materials.
Please upload the organization's most recent financial statements, including YTD profit & loss statement and current balance sheet.
Organizational Plans
What alternative structures is the organization considering?
Coming together with another organization (e.g., merger, shared services arrangement, or other formal collaboration)
Restructuring or reorganization (e.g., spin-out or discontinuation of a program or service line, entering a fiscal sponsorship arrangement)
Wind-down and/or dissolution
Other
Unknown
Are any other alternatives being considered? If so, please explain.
Please select any components that helped determine which pathways to consider.
Financial analysis
Stakeholder input (e.g., clients/community, funder)
Staff decision
Board decision
Lack of internal capacity to deliver programs/services
Legal constraints
Timeline urgency
Other
Has the organization developed a formal restructuring plan?
Yes
No
If yes, has the organization's board approved it?
Yes
No
If yes, please describe the plan here and/or upload it below.
Please upload restructuring plan here.
Change Readiness and Governance
What is the organization's timeline for making decisions about next steps?
Please select...
Immediate (next 30 days)
Next 90 days
Next 6 months
Longer than 6 months
Are there any milestones associated with decision-making that the organization is working toward in the short (~30 days), medium (up to 90 days), and long (past 90 days) terms? Please briefly outline.
What actions has the board taken (to date) or plans to take to address the situation?
Special/transition committee formed
Counsel retained
Votes held
Votes scheduled
Plan adopted
Other
What organizational stakeholders are aware of/engaged with the situation?
Staff (beyond senior staff)
Clients/community served
Major funders
Fiscal sponsor
Landlord or other vendors
Contracting agencies
Collaborating organization(s)
Other
Please briefly describe how any of the stakeholders selected have been engaged thus far.
Use of Funds
Requested Grant Amount
Primary Purpose(s) of Grant Funds
Operations stabilization
Retention of key staff/systems to execute transition
Technical assistance for restructuring/repositioning activity
Facilitation of wind-down/dissolution proceedings
Satisfaction of outstanding obligations/liabilities
Have you retained external counsel or advisors?
Yes
No
If yes, please list provider(s) and scope of services.
Please upload any scopes of work/services available for any providers engaged.
Please upload a 90 day budget for use of funds. Please include line items, descriptions, vendor(s)/firm(s) (if known), amount(s), and anticipated deliverables/milestones and dates associated with each line item.
Have you secured or requested additional funds to support these costs?
Yes
No
If yes, please list amounts and sources of additional funds, and the status of the request(s).
Internal and External Impacts
Community Impact
Who does your organization currently serve (please provide demographic and/or community information, as pertinent)?
What potential harm will this community(ies) face if services lapse?
Safety risk
Loss of essential services/basic needs access
Moderate disruption
Minimal disruption
Unknown
Are there other providers in your service area who may be able to provide continuity of services? Have you had conversation with them?
Please describe any preliminary plans for communicating changes in services to clients and referring/transitioning them to other providers.
Internal Impacts
Do you anticipate needing to furlough or lay off any staff to complete the transition?
Yes
No
If yes, has the organization made plans to support affected staff?
Outplacement
Severance
We will not be able to support staff in transition
Plans still unknown
If applicable, please outline any roles critical to the transition to retain. Please include titles and status (e.g., FTE or PTE; contractor vs. full-time employee).
Uploads and Certifications
Uploads
Please use this space to upload any additional documents to support the grant application. Examples may include letters of intent, memoranda of understanding, affiliation or transfer agreements, and/or scenario plan documents.
Upload #1
Upload #2
Upload #3
Upload #4
Upload #5
Certifications
By signing here, I certify that, to the best of my knowledge, all information on this form is factual and accurate.
By signing here, I certify that the organization's board is informed of this funding application and supports pursuing the proposed path.
By signing here, I acknowledge that the Nonprofit Repositioning Fund will need to share information from this form with the funders who support the work in order to make final funding decisions. Information will be kept confidential among NRF staff and funders, unless otherwise discussed.
Contact Information