Grant Application Community Health Grant Application Application Instructions and RequirementsGrant Window is January to September (See Dates Below)Grant Committee Review Schedule for 2025: January 7; March 4; June 3; and September 2. Please submit your grant request at least two (2) weeks prior to the meeting dates. Questions please call Tanya Moran at 530-642-9984 or email tmoran@marshallmedical.orgReportingReporting requirements are listed on the letter of acceptance that is provided to successful applicants. A final report template will be provided that compares your proposal to actuals. Grant Making ScopeWe fund programs and projects that benefit community health. We do not grant funding for operating expenses, capital improvements or programs and projects after the fact. Our service area for programs and projects is the Western Slope of El Dorado County. The organization must be a 501(c)(3) nonprofit or fiscally sponsored by a 501(c)(3) nonprofit organization.Date MM slash DD slash YYYY Contact InformationFull Legal Organization Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Organizational Website example: http://www.marshallfound.orgOrganization President/CEO/Executive Director* Position Title* Organization Phone Number*Organization Email* Grant Contact Name* Grant Contact Name Title* Grant Contact Phone Number*Grant Contact Email* Organization Information501(c)(3)* Yes No Year Established or Incorporated* EIN or TIN* Fiscal Sponsor Name (if applicable) If your organization does not have 501(c)(3) status, it can apply under a fiscal sponsor. If there is a Fiscal Sponsor, then attach a letter of commitment from the fiscal sponsor on their letterhead and signed by the CEO or CFO at the bottom of this application.Total Number of Paid Staff for your organization* Total Number of Volunteers for your organization* Mission Statement*(350 Characters or less)Brief Description of Organization*(500 characters or less)Attach or Provide URL for Annual Report (if applicable) Population Served or Target Population*(200 characters or less, include age groups, race and ethnicity, income levels, etc.) As appropriate, include the number of people at risk and/or homeless to be served. Please specify whether the numbers provided are duplicated or unduplicated.Proposal RequestProgram / Project Name* Total Program / Project Budget (from all sources)* Requested Amount* Percent of Total Budget Requested* What health care related services will the target population receive?*Has Marshall Foundation For Community Health provided funding in previous years?*YesNoIf so, in which years? Geographic Area Served (MFCH provides funding for the Western Slope of El Dorado County).*What would this funding provide?*Is this Program / Project:*New program / projectFunding to operate an existing program / projectExpansion of an existing program / projectDescribe the need this Program / Project will meet:*(and provide additional information and data demonstrating the need exists)If you are collaborating with other organizations, list them and describe the collaboration.*(if none, state "None" )What evidence or experience does your organization have to support your qualifications for successfully meeting the need?*How will this program / project address the needs of the target population?*What is the program / project timeline and major milestones?*What is the anticipated impact of this program / project? (quantify this)*How will you measure the impact of this program / project to know if it was successful?*Number of unduplicated clients to be served with this program / project if funded?* What services will these clients receive?*If this is a clinical program, what is the standard recidivism rate? If not, enter N/A.Please include the following with your request: History of Organization and Areas Served 501(c)(3) IRS Letter of Determination Project Budget and Other Sources of Financial or Collaborative Support Letters of Support List of Board and/or Advisory Committee Members Fiscal Sponsor Letter of Commitment (if not a 501(C)(3)) File Upload Drop files here or Select files Max. file size: 512 MB. SAVE AND CONTINUE INSTRUCTIONS - PLEASE READ!The link below is secure and system generated! PLEASE be sure to send the link to your EMAIL address or copy and paste your link to your saved location. This system DOES NOT re-open where you left off if you close this screen.
