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Online Grant Application Form
Contact Us
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Online Grant Application Form
Name of Organization:
Charitable Donation Number:
Name:
(Required)
First
Last
Phone:
(Required)
Email:
(Required)
Address
Street Address
Website
Mission of the Organization:
0 of 500 max characters
Key Activities of the Organization:
(list 3 max)
Number of Volunteers:
Number of Paid Staff:
DESCRIPTION OF PROJECT
Name of Proposed Project/Program:
Focus of Grant Request:
(may use more than one box)
Food Supply
Clothing and Shelter
Transportation
Health Promotion (physical, cognitive, mental health, psychosocial needs)
Social Isolation and Loneliness
Other: (Please Specify)
Other:
Brief Description, including how the project aligns with the LMF priorities above:
Number of persons over 65 who will benefit from the specific program/project:
Is this a new Initiative?
yes
no
If not new, how long has it been in operation?
How was a need for this project established?
How is this proposal different from other existing services in the community?
How will you determine the success or failure of your project/program?
How will outcomes be sustained over the long-term?
BUDGET FOR PROJECT
Total Amount of Grant Request:
(Required)
Is this a one-time, or Sustainable Grant Request?
*Sustainable option is not available for first-time requests
One-time
Sustainable (Max 3 years)
Present the financing profile of this initiative
Government funding:
percentage
Please enter a number from
1
to
100
.
Internal funding:
percentage
Please enter a number from
1
to
100
.
Other sources of funding:
percentage
Please enter a number from
1
to
100
.
Please specify 'other sources' if applicable:
BUDGET DETAILS
PLEASE PROVIDE AS MANY DETAILS OF THE BUDGET AS POSSIBLE
FOR THIS PROJECT/PROGRAMME SPECIFICALLY
USING THE FIELDS BELOW.
*IF AN ITEM IS NOT IN YOUR BUDGET, JUST WRITE N/A
Material Resources:
Example: food, shelter, supplies, equipment
Material Resources Details:
Example: food, shelter, supplies, equipment
Human Resources:
Example: stipends, salaries
Human Resources Details:
Example: stipends, salaries
Transportation:
Transportation Details:
Technology:
Technology Details:
Social Activities:
Social Activities Details:
Other Activities:
Other Activities Details:
AUTHORIZATION & REQUIRED INFORMATION
Authorized by:
Board of Directors
Senior Management
Other
If "Other" Please Specify:
Additional Comments (if Needed):
For File Attachments: Please Read Instructions at Bottom of Page
Signature:
* if different from above
First
Last
Title/Function:
Date
MM slash DD slash YYYY
Attachments (Please send most recent reports):
Annual Report
Financial Statements/Auditor’s Report
Other
Annual Report – upload file
Max. file size: 512 MB.
Financial Statements/Auditor’s Report – upload file
Max. file size: 512 MB.
Other – upload file
Max. file size: 512 MB.
Other – please specify:
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