Grant Application

Online Grant Application

Name of Organization *

Legal name of 501(c)(3) *

Tax ID Number *

Main office address *

Main office address

Address 1

Address 2

City

State/Province

Zip/Postal

Main office phone number *

Website URL *

Primary Contact *

Title *

Phone number *

Email *

Grant amount requested *

Project name or title *

1. Please provide a one-sentence description of the program for which you are requesting support. *

Please limit to 75 words

2. Please provide an organizational background, including mission, objectives, and history.. *

Please limit to 200 words

3. Please provide a brief snapshot of your organization’s financial health, including historical and projected plans for your financial sustainability. *

Please limit to 200 words

Number of individuals with ASD currently served by the organization *

Age range of the individuals with ASD served by the organization *

Organization’s Total Budget *

Number of individuals with ASD that are anticipated to be directly served by this grant *

4. Please describe the program for which you are seeking funding. Include scope of project, targeted population, length of program, and program rationale. *

Please limit to 650 words

5. Please describe the criteria used for accepting participants into the program, including any criteria that would exclude participants who do not qualify. If there are published eligibility criteria, please attach them below. *

Please limit to 200 words

6. Please explain how this program will improve outcomes for individuals with ASD. Include supporting evidence and/or research, if any, for your program and its methodology. How will you measure individual outcomes resulting from this project? *

Please limit to 200 words

7. What is the intended impact of this project? Describe the methodology that you will use to measure and report the progress, impact, and success of this program. *

Please limit to 200 words

8. Please specify which underserved and/or low-resource communities the program will directly help? What percentage of your target population do you expect will be underserved and/or low-resource? *

Please limit to 200 words

8a. What specific measures will be employed to ensure that the program is accessible to underserved and low-resource communities? Describe plans to provide financial aid, if any. *

8b. Describe your plans to conduct outreach to underserved and low-resource communities. *

9. Are there plans to include participants who do not have ASD in the program? If so, kindly describe and include the number of such participants, any related demographic information (e.g., age, diagnosis if applicable) and if available, the ratio to those with ASD. *

Please limit to 200 words

10. How is this program innovative? In what way, if any, does the program change a system of service delivery? *

Please limit to 200 words

11. Is your organization willing to disseminate the program to other organizations? If so, kindly describe your dissemination plan. *

Please limit to 200 words

12. Please indicate how the organization will document or codify the program in order to ensure continuity within the organization and dissemination? *

Please limit to 100 words

13. Please outline your plans to sustain the program in terms of resources received from outside the organization as well within the organization. Kindly include all collaborations with outside organizations or additional support. Please also list additional funding received or expected. *

Please limit to 200 words

14. If you are applying for a NEXT for SAFETY grant, please indicate police departments with which you currently partner or plan to partner, the structure of the partnerships, and key contacts. (Note: a pre-existing relationship is not required.) *

Please limit to 300 words

15. Please use this space to provide additional critical information that you would like to share with us. *

Please limit to 200 words