2024 Impact 100 Letter of Intent Submission Form

2024 Impact 100 Letter of Intent Application

The Impact 100 Letter of Intent is an online form for Greater Cincinnati, Northern Kentucky, and Eastern Indiana. This contains the information necessary to submit your Letter of Intent. If you have any questions, please feel free to contact us at grants@impact100.org

"*" indicates required fields

Step 1 of 7

14%

Organizational Information

Organization Legal Name*

Organization Doing Business As (DBA) Name

If applicable

Federal Employer Identification Number (EIN)*

Please exclude the dash

Year Founded*

Annual Operating Budget*

Under $500,000

$500,000 - $999,999

$1,000,000 - $4,999,999

$5,000,000 - $9,999,999

$10,000,000 and over

Organization Address*

Street Address City State / Province / Region ZIP / Postal Code

Organization Phone*

Organization Website

Must include "https://" at the beginning to be accepted

Application Contact Name*

First Last

Application Contact Title*

President, Development Director, etc.

Application Contact Email*

Enter Email Confirm Email

Application Contact Phone*

I am the Executive Director of the Organization*

Please identify if you (the person applying) are the Executive Director/President/CEO of the Org applying

Yes

Executive Director Name

First Last

Executive Director Email

Enter Email Confirm Email

Organization Vision & Mission Statement*

Organization Core Programs & Services*

Organization Focus Area*

Indicate which Impact 100 Focus Area the organization is aligned with.

Culture: Cultivate, develop, educate and improve the cultural climate.

Education: Further the ability to educate and improve education.

Environment, Recreation & Preservation: Preserve, enhance, revitalize or restore facilities and surroundings.

Family: Strengthen and enhance the lives of children and families.

Health & Wellness: Positively impact the mental or physical health and wellness of people.

Project/Program Proposal

Project/Program Title*

Type of Request*

Please pick the choice that best matches your grant request.

New Initiative/Project Start-up

Expansion of Existing Program/Project

Capital

Technology

List the counties that will be served by this project or program*

Check all counties impacted/served by the project or program

Adams, OH

Boone, KY

Brown, OH

Butler, OH

Campbell, KY

Clermont, OH

Dearborn, IN

Hamilton, OH

Kenton, KY

Warren, OH

Other

If other, please indicate which counties outside those listed above will be served by this project or program.*

What problem/issue/community need are you addressing, and how does your project or program impact it?*

Briefly describe your project/program in 2-3 sentences*

Transformational Impact

How is your project/program transformative and addressing community issues at a systemic level?*

How many individuals do you plan to impact or engage with the project/program? Describe the depth and/or breadth of impact anticipated.*

Diversity, Equity, & Inclusion

Briefly describe the demographics of those you serve (e.g., race/ethnicity, age, gender, location, sexual orientation, (dis)ability, etc.) and how disparities among these populations are addressed by your organization and programs.*

Organization/Strategic Fit

Where does this project fit within your organizational strategy and vision?*

Financial: Project Budget

An Impact 100 grant is $100,000 that can be used over a 1–3-year period starting no earlier than 10/1/24 (can start later). With that in mind ...

Over what timeframe do you anticipate using the grant?*

1 Year

2 Years

3 Years

Not Yet Sure

What is the total budget for the project/program over that same timeframe?*

Please enter a number greater than or equal to 100000.

Describe how you anticipate Impact 100 funds being used*

Describe major categories of spending such as salaries, equipment, marketing, construction, etc.

If the total project/program budget exceeds $100,000, how will additional funding be secured?*

If your budget = $100,000, just enter N/A below.

Authorization & Acknowledgements

The following questions are for internal use only and will not be shared outside of the Board of Impact 100.

By submission of the application, I confirm the Executive Director and/or Board President are aware that this application is being submitted.*

Yes

Unsure

The organization does not have current or pending legal conflicts.*

By submitting the LOI, you are agreeing to disclose any current or pending legal conflicts via an email to grants@impact100.org at any time during the grant review cycle.

Our organization does have current or pending legal conflicts.

Our organization does NOT have current or pending legal conflicts.

Please describe the current or pending legal conflict.

CAPTCHA

Please hit SUBMIT only when you have completed the LOI. A confirmation email will be sent to the email addresses submitted.

If no email confirmation is received from administration@impact100.org within 1 hour please check your junk mail or spam folder.

Name

This field is for validation purposes and should be left unchanged.