Organization Name:

Address:

City:   State:   Zip:

Telephone:   FAX:

Email:

Executive Director:

Phone:

Contact Person/Title:

Phone:

Total Annual Program Budget:

Organization History and Mission
In this section we would like to understand how your organization was started. Is it a national or local organization? What has been its growth over the last three years? What are its vision and top strategic objectives for the future? How would you see yourself in 3-5 years? What are your key needs and barriers to success?


Other Agencies You Work with Formally and Informally:


Are there any Specific Requirements your Organization Needs to Meet or Maintain which Relate to Regulations by Community and or Government Agencies, or Otherwise.

Requested Amount, Use of Funds, and Timeline for Use of Funds.
In this section, we are interested in understanding the specific request, how it will be used, when the funds will be needed and over what period of time. Further, what is the impact of the funding on the organization? Please identify what percentage of the requested funding would fit into the following categories:Empowerment Investment? This would include funding that either significantly expands the scope of the organization’s offering, dramatically increases the number of people the organization can help, or provides a self-funding solution that will dramatically reduce the organization’s dependence on outside funding. We look at these types of investments as the most desirable and ones we would expect to be of a specific duration. Strategic Funding? Similar to the first category, but if supported, the organization would need long term funding to sustain the program. Tactical Investment? This would be a specific duration request to modernize, replace, refurbish, or establish support facilities, equipment or other needs. Once completed, the Organization’s general funding would be able to maintain these improvements. They would not change the scope of the services you offer but would update your capability to meet those needs.

Tactical Funding? Request for general funding of ongoing operations of the Organization.

Specific Benefit of Gift

In this section we are interested in understanding your specific objective for these funds and how you will measure your efforts to confirm if you are reaching your goals. In other words, how will you know if you met your goals?


How Would this Grant Help Realize One or More of the Foundation’s Goals? (Women, Children, Families, Poor, Education and Health Care)

Percentage of Total Income and Other Key Providers over last three years.

In this section, we want to understand who are the primary funding groups or methods for your Organization (greater than 5% of funding) and what percentage of funding St. Benedict’s Foundation provides. We also want to understand how/if this has changed over the last three years.

Empowerment Opportunities

St. Benedict Foundation has established an ad hoc Social Entrepreneurship Committee with the specific intent of helping the Foundation as well as Organizations that it funds to identify and develop opportunities that leverage their resources to increase independence or expand the Organization’s capabilities. Would your Organization be interested in working with this committee to help identify such opportunities, or do you have opportunities you would like to have the committee review?

Reporting

Please call the Foundation for a copy of the reporting form appropriate to your agency. (801) 479-1800. Please review that form and confirm that you will commit to providing this update. If you are unable to do so please explain why, understanding that if you commit to completing this form and are unable to do so, funding could be withheld until such time as the reason for delay is resolved.

Income Disclaimer

As we have stated in the past, St. Benedict’s Foundation cannot continue to be a primary source of funding and there are no guarantees that funding will be granted or continued. If you have questions regarding your proposal or this letter, please call the Foundation at 479-1800. If we are out of the office, please leave a message and we will return your call. Print this document and fax to: (801) 479-4997 or submit online.