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2025 Impact 100 Grant Application
Section 1: General Organizational Information
Organization Legal Name
(Required)
Organization Doing Business As (DBA) Name
If applicable
Application Contact Name
(Required)
First
Last
Application Contact Title
(Required)
Application Contact Email
(Required)
Enter Email
Confirm Email
Application Contact Phone
(Required)
Section 2: General Project Information
As a reminder, the project for which a grant is being requested must be essentially the same project as was presented in the LOI.
Project/Program Title
(Required)
Indicate any changes that have occurred to your organization or this project since the LOI was submitted.
Section 3: Program/Project Details
Describe the goals & objectives of the proposed program/project
(Required)
Describe your program/project in detail, including timeline for implementation and ongoing operation
(Required)
What are the success factors of your program/project that make you confident it will deliver expected results?
(Required)
(e.g., past results, adoption of best practices from other successful programs/organizations, use of evidence-based practices, etc.)
Will this program/project involve working in partnership with other organizations? If so, with whom and how?
(Required)
If this is a collaborative proposal, include Letters of Commitment from Collaborating Organizations (PDF only)
If possible, combine all letters into ONE PDF document. If this is not possible, this field will allow for up to 4 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 4.
Section 4: Transformational Impact
State the specific outcomes you hope to achieve with the proposed program/project.
(Required)
Please provide specific, quantifiable targets for each outcome.
How will you measure transformational impact?
(Required)
Indicate how evaluation is part of the project.
(Required)
Include information about specific data capture and measurement tools, how clients are involved in data capture and evaluation, and how results are used and disseminated.
Section 5: Community Voice & Representation
In what ways is your organization representative of the people you serve and their needs/issues?
How are those you intend to serve involved in envisioning, designing, and/or implementing this project/program? Have they been consulted?
(Required)
Describe how your organization is promoting diversity and belonging.
(Required)
Please include efforts related to board, staff, clients, and programs.
Section 6: Organization/Strategic Fit
What successes has your organization achieved in the past three years?
(Required)
What makes your organization unique and especially qualified for this project/program, as compared with other organizations working in your geographic area with similar populations?
(Required)
Upload Organizational Chart or List of Key Staff Members
(Required)
Please, if possible, combine all requested data into ONE PDF document. If this is not possible, this field will allow for up to 2 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 2.
Upload Names & Affiliations of Board Members
(Required)
Please, if possible, combine all requested data into ONE PDF document. If this is not possible, this field will allow for up to 2 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 2.
Section 7: Financial Information
How is your organization currently funded
(Required)
Funding could include donations/contributions, government contracts, earned revenue, in-kind support, special events, fundraisers, etc.
As a reminder, An Impact 100 grant is $100,000 that can be used over a 1-3 year period starting no earlier than 10/1/24. With that in mind...
Over what timeframe do you anticipate using the grant?
(Required)
If uncertain, please select 3 years
1 year
2 years
3 years
What is the total budget for the project/program over that same timeframe?
(Required)
Budget should be for the whole project, not just the Impact 100 portion. If you selected 2 or 3 years above, the amount should be the cumulative total across the 2 or 3 years. The number entered here should match the total budget you enter on the Project Budget tab of the Financial Workbook in Section 8 of this application.
Please enter a number greater than or equal to
100000
.
List other funders to which this current proposal has been and will be submitted.
(Required)
For each funder, indicate amount requested and status of request, i.e., request will be submitted, is pending, was funded or was declined. If funded, specify amount of grant. If there are no other funding requests planned, please place a "0" in each field.
Funder
Amount
Status
Add
Remove
Describe any other anticipated funding for this current project.
(Required)
Funding could include contributions/donations, government contracts, earned revenue, in-kind support, special events, fundraisers, etc.
What are the long-term strategies for funding the ongoing costs of this project beyond the grant period?
(Required)
Section 8: Required Financial Attachments
All uploaded documents should be in PDF format except the Financial Workbook (xlsx). We PREFER all PDFs to be combined into one document per section. However, we will accept multiple files per upload if this cannot be accomplished due to your current technology. All files must be 128MB or smaller. If you need to compress a larger file visit Adobe.com and search for "Compress PDF."
All grant applicants must complete the Financial Workbook. CLICK HERE TO DOWNLOAD THE FINANCIAL WORKBOOK. Once complete please save & upload as an Excel file.
Upload Completed Financial Workbook
(Required)
Drop files here or
Select files
Accepted file types: xlsx, Max. file size: 128 MB, Max. files: 1.
Statement of Activities (aka P&L Statement) for your organization's most recently completed fiscal/calendar year and the previous two years
(Required)
Please, if possible, combine all requested data into ONE PDF document. If this is not possible, this field will allow for up to 2 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 2.
Statement of Financial Position (aka Balance Sheet) for most recently completed fiscal year and the previous two years
(Required)
Please, if possible, combine all requested data into ONE PDF document. If this is not possible, this field will allow for up to 2 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 2.
Most recent audited financial statements complete with notes and audit opinion as well as any other opinion or report issued by the auditing firm for the organization
(Required)
If your organization does not have an audit performed, provide one of the following for each of the three most recent years (in the order preferred): a) Independently reviewed or compiled financial statements, or, b) Form 990. Please, if possible, combine all requested data into ONE PDF document. If this is not possible, this field will allow for up to 3 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 3.
If there will be ongoing expenses, beyond the stated grant period, associated with your project, and if those expenses increase your organization’s operating budget by 20% or more, please attach a high level summary budget
The summary budget should show how your organization plans to cover the additional operating expenses after the grant period/money has been spent. (For example, it may be through increased revenue, partnerships, other grant sources or donations/fundraisers, etc. This attachment would show the increased expenses and the source of the income to cover them.) The purpose of this is to show how your organization plans to sustain the work and the impact of your project. Please, if possible, combine all requested data into ONE PDF document. If this is not possible, this field will allow for up to 2 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 2.
Optional File Upload
Use this field to upload any additional financial files. For example, if you have bids or estimates to support a capital project request, upload them here. Please, if possible, combine all requested data into ONE PDF document. If this is not possible, this field will allow for up to 2 PDFs to be attached.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 128 MB, Max. files: 2.
Section 9: Signatures
by Executive Director
(Required)
Submitted by
(Required)
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