Grant Application

* Indicates required field

Name of Organization *

Amount Requested *

Title of Project *

Organization Address *

Line 1

Line 2

City

State

Zip Code

Country

Web Site *

Facebook Page *

Date Organization was established *

Annual Organization Operating Budget *

Contact Information

Executive Director Name & Title *

Email *

Phone number *

Project Manager & Title, if applicable *

Email *

Phone number *

Board Chair *

Email *

Phone number *

Grant Budget Request

Total $ Projected Budget *

Total $ Requested from WISE Women of Blair County *

Project Implementation Date *

SELECT WHETHER THIS IS A NEW OR AN ONGOING/EXISTING PROJECT *

New Ongoing/Existing

SELECT GRANT MAKING PRIORITY WHICH BEST DESCRIBES THE PROJECT:

Choose All that Apply *

Empowering Women Eliminating Racism

through

Choose All that apply *

Collaboration Service Education

Project Summary

Please describe your project in fifty (50) words or less *

Population Served

Geographic Area To Be Served by your project *

Number of People to be served by your project *

Gender of people to be served by your project *

Special Population(s) Being Served *

Previous WISE Women Grants - please list the most recent grant received by WISE Women of Blair County

Award Date and Award $ Amount *

Signatures - Signatures of both Board Chair and Executive Director of the applying organization are required. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application.

Board Chair Signature *

Executive Director Signature *

Date *

Organization Information

1. Briefly describe your organization's history, mission and goals. *

2. Identify the population your organization benefits. (socioeconomic status, language, age, physical abilities, other descriptions) *

Project Information

3. Describe the proposed Need to Be Met. Please specify the need or problem to be addressed and how this project advances the mission of WISE Women. *

4. Describe project in detail and tell how it will work, noting its purpose, target population to be served, the methods and approaches to be used to implement the project, etc. Also, include collaborative partners for this project, if applicable. *

5. Project outreach to participants. Describe how you will promote the project to the target audience in order to get participants. *

6. Project Publicity. Describe how you will acknowledge WISE Women of Blair County. *

7. Project goals and objectives and the anticipated timeline for implementation. Describe your work plan, timeline, what services will be provided and where specific services will be located. *

Expected Outcomes and Evaluation Process

8. Expected outcomes used to evaluate the project's Effectiveness. What are the expected outcomes of the project. *

9. Methods used to evaluate whether benchmarks or outcomes were accomplished. Describe how success will be defined and measured. *

10. Ability to use these funds to leverage other funds. List other funding sources for this project and amounts received or anticipated. *

11. Describe how your organization plans to sustain and fund this project after the WISE Women funds are spent. *

12. If your organization received a grant from WISE Women the previous yar from this granting year, and you are reapplying for a grant for the SAME PROJECT, please provide an interim report of the project along with this application. *

Board of Directors

Please upload a File containing the names and titles of your board of directors. *

Max file size: 20MB

Project Budget Spreadsheet

Please fill out the separate Project Budget Form and upload it to your Grant Application below.

Please Upload the Project Budget Spreadsheet. The form can be found on the GRANT home page. *

Max file size: 20MB