2022 Annual Grant Round

2022 Grant Round: Full Question Set

Suggestion: Prepare a separate document with answers to the questions listed below and copy and paste your organization’s answers into the form. The online form will be made available on June 3^rd at 9 am and lacks the ability to save your work and return it for submission. Only copy and paste once you are ready to hit submit.

ORGANIZATION INFORMATION

• Complete Legal Name of Organization
  • (Include Doing Business As name if applicable)
• EIN Number
• Organization's Street Address
• City
• State
• WA
• Zip Code
• Link to Website
• Your Organization's Mission Statement

CONTACT INFORMATION

Please provide contact information for the person who is the primary contact for the project/program and the authorized signatory for grant funds.

• Primary Contact Person's Name
• Primary Contact's Title
• Primary Contact Person's Telephone
• Primary Contact Person's Email

QUALIFICATION

Applicants must either be a 501(c) organization, school or governmental entity or tribe or they must have a fiscal sponsor that qualifies as a tax-exempt organization under the Internal Revenue Code.

Tax Status:

• Section 501(c) Public Charity
• Federally Recognized Tribe
• Unit of Government
• Fiscally Sponsored Project

The work of your organization is best described by (select all that apply):

• Health Equity
• Immigrant and Refugee Assistance

Explain how the work of your organization is considered Health Equity and/or Immigrant and Refugee Assistance. (Please keep answers to 300 words or less.)

Where is the organization's primary location or primary/significant service area? (Select all that apply)

• Zillah
• Buena
• Granger
• Wapato
• Harrah
• Status
• Parker
• Toppenish
• White Swan
• Brownstown
• Medicine Valley
• Outlook
• Sunnyside
• Grandview
• Mabton
• Kittitas County

Total Amount of Request*

Please select from the options below.

• $5,000
• $10,000
• $15,000
• $20,000
• $25,000

PROPOSAL SUMMARY: CAPACITY BUILDING

Provide a three-sentence summary of your proposal. (Please keep answers to 300 words or less.)

This grant round focuses on two approaches to capacity building: general operations and organizational development.

• General Operations support existing program or operating costs.
• Organizational Development strengthens the organization's programs, leadership, and/or infrastructure.

Based on the definitions above, please select which approach to capacity building that best fits your request (please select one of the options below):

• General Operations
• Organizational Development

Use specific examples to describe how this approach will support your organization. (Please keep answers to 300 words or less.)

Describe the challenge(s) your organization will address with this funding. (Please keep answers to 300 words or less.)

EQUITY AND INCLUSION

How does your organization's Board of Directors reflect the community you serve? (Please keep answers to 300 words or less.)

What population, sectors, or groups of people does your organization serve? (Please keep answers to 300 words or less.)

How do you gather and implement feedback from the communities you serve? (Please keep answers to 300 words or less.)

Please describe how your organization values culture and identity. (Please keep answers to 300 words or less.)

CONFIDENTIALITY

All grant applications are considered confidential. Organization names are published ONLY if awarded funding. If you have specific requests or concerns regarding confidentiality, please describe them below.

Required Attachments

1. Program/Project Budget: (Please make sure your budget adds up to the request amount.)
2. Board of Director Roster (Name, Title, Board Role. Please provide if available: Ethnicity/Race, Gender.)
3. Your Organization's 2021 Q4 Financial Statement or most recent audited financial statement
4. Your Organization's W9