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Grant Application Form
Jewish Women’s Foundation of South Palm Beach County (JWF)
DUE DATE:
Monday, December 15, 2014: Applications with all required information and audit report attachments are due
in the JWF office no later than 5 p.m., Eastern Standard Time. Complete Grant Applications can be submitted
via email to [email protected]. In order for Grant Applications to be considered received by JWF, you
must receive an email confirmation of receipt from JWF within two business days. Late Grant Applications will
not be accepted.
INSTRUCTIONS:
Please complete all questions below and number the pages of the Application Form, Proposal Narrative and
Program Budget Form and Budget Notes (all in one Word attachment). Please use a 12 point font and adhere to
page limits and the application format. Please submit the most recent audit report in a separate PDF attachment
from the application. If you have any questions, please contact Lisbeth Rock Cauff, Director of JWF via email
at [email protected], or at 561-852-3188.
Organization Contact Information:
Organization:
Program Title:
Address:
Contact Person and Title:
Telephone:
Fax:
E-mail:
Website:
Year Organization was Founded:
Executive Director (if different than Contact Person):
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JWF of South Palm Beach County Grant Application, Page 2
Questions:
1. Is your organization a tax-exempt 501(c) 3? Yes__________
No__________
2. If not, what organization will serve as your Fiscal Agent?
3. Amount requested: $_______________
4. Which grant category do you believe your program would fit in best? (Please underline the appropriate
category. Please refer to the Grant Categories page on our website for more information.)
•
•
•
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! Economic Security/Legal Reform for Women and Children
! Health and Abuse Prevention for Women and Children
! Education/Leadership Development for Women and Children
! Other
Geographic focus (Please underline the appropriate region.):
South Palm Beach County
U.S.
Israel
Other (specify):
5. Has your organization applied for funding from JWF of South Palm Beach County in the past?
Yes __________
No __________
6. If yes, did you receive funding? Yes__________
No__________
7. If yes, when?
8. If yes, how much was the amount for which you received funding? $ _______________
9. What other Jewish Women’s Foundations within the United States have you applied to?
10. If so, please list which JWFs you have applied.
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JWF of South Palm Beach County Grant Application, Page 3
11. If so, when did you apply?
12. If so, what funding amount did you apply for?
13. Are you reapplying for the same program? Yes__________
No__________
14. If not, how does this program differ from the previous program for which you applied?
15. Number of people to be served by program: _______
16. How many are Jewish women? __________
17. How many are Jewish children? __________
Girls: __________
Boys: __________
18. Number of Board members: __________
19. How many Board members are Jewish women? __________
20. Please provide a 50 word Summary of the program for which you are seeking JWF funding:
Proposal Narrative:
Please attach a Proposal Narrative (maximum of 5 pages in 12 point font) incorporating the following points:
1.
Organizational Overview: Provide a brief overview of the agency’s mission and ongoing programs. Who is
your organization’s constituency? Be specific about demographics such as gender, religion, age, sexual
orientation, race, and people with disabilities. Briefly describe how your organization operates: what are the
responsibilities of board, staff, and/or volunteers? If a membership organization, define the criteria for
membership. Include a brief paragraph summarizing the qualifications of key individuals involved in
carrying out the plans outlined in this request.
2.
Problem Statement: In one paragraph, please state what needs or issues the program addresses.
3.
Program Description: Describe the program for which support is sought. How does this program address
the root causes identified in the problem statement? How will the overall status of Jewish women and/or
girls be improved by this program? Please be specific regarding the demographics of the target population
including gender, religion, age, sexual orientation, race and people with disabilities. Please indicate if this
is a new or ongoing effort. If applicable, please describe how participants will be recruited and whether
your organization will collaborate with any other organizations or individuals on this program.
4.
Indicators of Social Change: From the list of indicators of social change below, which “shift(s)” best
applies to your program and why? If your program addresses more than one of the indicators, please select
the top two that most clearly reflect the work outlined in this application.
•
Attempting to shift definitions and/or reframe issues: The issue is defined differently in the
community or larger society as a result of your work.
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•
•
•
•
5.
JWF of South Palm Beach County Grant Application, Page 4
Attempting to shift individual and community behavior: People are behaving differently in the
community or larger society as a result of your work.
Attempting to shift critical mass and engagement: People in the community or larger society are
more engaged as a result of your work
Attempting to shift institutions, systems and policies: An institutional, organizational, or
legislative policy or practice has changed as a result of your work.
Maintaining earlier progress: As a result of your work, past gains have been maintained,
generally in the face of opposition.
Goals and Objectives: What are the goals and specific, measurable objectives for the program? Please
make sure that your objectives are reasonable and achievable within the funding period, and that they map
out a clear strategy for achieving the shift(s) in social change you identify above.
6. Evaluation: How will you know you have achieved the social change shift(s) your organization desires?
7. Who will be involved in evaluating the program -- staff, board, constituents, community, consultants? How
will the evaluation results be used?
8. Who is the contact person responsible for submitting the evaluation?
9. Funding Status and Plans: What is the current source of funding for this program?
10. From where else will funding be sought?
11. How will the program be maintained after support from JWF is discontinued? Please be as detailed as
possible. Reminder: The JWF awards a maximum of 3 years of support to a program.
12. PROGRAM BUDGET FORM
Staff Training
Consultants, Professional Fees, Speakers
Travel/lodging
Food/beverage
Equipment
Supplies
Printing and Copying
Telephone and Fax
Postage and Delivery
Rent
Utilities
Evaluation
Marketing/Advertising/Publicity
Other (specify individually)
TOTAL EXPENSES
13. SOURCES OF PROGRAM REVENUE
A. Total
Expenses
________
________
________
________
________
________
________
________
________
________
________
________
________
________
________
B. Committed
Revenue
C. Anticipated
Revenue
D. (B + C)
Total Revenue
Grants/Contracts/Commitments
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JWF of South Palm Beach County Grant Application, Page 5
Government
________
________
________
Foundations
________
________
________
Corporations
________
________
________
Jewish Federation of SPBC
________
________
________
Individuals
________
________
________
Earned income (admission fees, etc.)
________
________
________
In-kind support (indicate source)
________
________
________
Other revenue (please specify)
________
________
________
TOTAL REVENUE
________
________
________
14. PROGRAM FUNDS NEEDED
Total Expenses in excess of Committed Revenue (Total A minus Total B)
Total Expenses in excess of Total Revenue (Total A minus Total D)
________
________
15. AMOUNT REQUESTED (cannot exceed $20,000)
________
16. BUDGET NOTES:
Please explain what budget items will cover, variations, or to detail substantial in-kind support such as free
office space, volunteer time, etc. Sample: Budget Notes:
“Consultant fees requested from JWF of South Palm Beach County will cover: describe nature of consultant’s
position(s), necessary qualifications, projected hours, projected cost per hour, projected product(s), projected
expenses and supplies, etc. as applicable.”
“Staff training expenses requested from JWF of South Palm Beach County will cover cost of materials, space
rental, tuition, etc. as applicable.”
17. Please list senior staff members.
18. Please list Board Members and their professional affiliations.
Application Check List: Please adhere to the application format when submitting the following items in the
order listed below in two files – one with all information except the audit – the audit should be submitted in its
own PDF file. All information must be provided in English. In order for Grant Applications to be considered
received by JWF, you must receive an email confirmation of receipt from JWF within two business days.
Incomplete applications will not be accepted.
Required items:
 Completed JWF Grant Application Form
 Proposal Narrative (maximum of 5 pages, 12 point font)
 Program Budget Form and Budget Notes
 List Sources of Program Revenue with support over $1,000. Please include amounts granted and whether
revenue is currently committed or anticipated.
 List of senior staff members
 List of Board members and their professional affiliations
 Most recent audit report (in a separate attachment)
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JWF of South Palm Beach County Grant Application, Page 6
Please submit the Grant Application to Lisbeth Rock Cauff, Director of JWF at: [email protected] by
5 p.m. EST on Monday, December 15, 2014.
Lisbeth Rock Cauff
Director
Jewish Women’s Foundation of South Palm Beach County
9901 Donna Klein Boulevard
Boca Raton, FL 33428
USA
Telephone: 561.852.3188
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