Grant Application

Application Instructions and Requirements

Grant Window is January to September (See Dates Below)

Grant Committee Review Schedule for 2024: February 1; April 4; and August 1. Please submit your grant request at least two (2) weeks prior to the meeting dates. Questions please call Tanya Moran at 530-642-9984 or email tmoran@marshallmedical.org

Reporting

Reporting requirements are listed on the letter of acceptance that is provided to successful applicants. A final report template will be provided that compares your proposal to actuals.

Grant Making Scope

We fund programs and projects that benefit community health. We do not grant funding for operating expenses, capital improvements or programs and projects after the fact. Our service area for programs and projects is the Western Slope of El Dorado County. The organization must be a 501(c)(3) nonprofit or fiscally sponsored by a 501(c)(3) nonprofit organization.

Date

Contact Information

Full Legal Organization Name*

Address*

Street Address Address Line 2 City State ZIP Code

Organizational Website

example: http://www.marshallfound.org

Organization President/CEO/Executive Director*

Position Title*

Organization Phone Number*

Organization Email*

Grant Contact Name*

Grant Contact Name Title*

Grant Contact Phone Number*

Grant Contact Email*

Organization Information

501(c)(3)*

Yes
No

Year Established or Incorporated*

EIN or TIN*

Fiscal Sponsor Name (if applicable)

If your organization does not have 501(c)(3) status, it can apply under a fiscal sponsor. If there is a Fiscal Sponsor, then attach a letter of commitment from the fiscal sponsor on their letterhead and signed by the CEO or CFO at the bottom of this application.

Total Number of Paid Staff for your organization*

Total Number of Volunteers for your organization*

Mission Statement*

(350 Characters or less)

Brief Description of Organization*

(500 characters or less)

Attach or Provide URL for Annual Report (if applicable)

Population Served or Target Population*

(200 characters or less, include age groups, race and ethnicity, income levels, etc.) As appropriate, include the number of people at risk and/or homeless to be served. Please specify whether the numbers provided are duplicated or unduplicated.

Proposal Request

Program / Project Name*

Total Program / Project Budget (from all sources)*

Requested Amount*

Percent of Total Budget Requested*

What health care related services will the target population receive?*

Has Marshall Foundation For Community Health provided funding in previous years?*

If so, in which years?

Geographic Area Served (MFCH provides funding for the Western Slope of El Dorado County).*

What would this funding provide?*

Is this Program / Project:*

Describe the need this Program / Project will meet:*

(and provide additional information and data demonstrating the need exists)

If you are collaborating with other organizations, list them and describe the collaboration.*

(if none, state "None" )

What evidence or experience does your organization have to support your qualifications for successfully meeting the need?*

How will this program / project address the needs of the target population?*

What is the program / project timeline and major milestones?*

What is the anticipated impact of this program / project? (quantify this)*

How will you measure the impact of this program / project to know if it was successful?*

Number of unduplicated clients to be served with this program / project if funded?*

What services will these clients receive?*

If this is a clinical program, what is the standard recidivism rate? If not, enter N/A.

Please include the following with your request:

History of Organization and Areas Served
501(c)(3) IRS Letter of Determination
Project Budget and Other Sources of Financial or Collaborative Support
Letters of Support
List of Board and/or Advisory Committee Members
Fiscal Sponsor Letter of Commitment (if not a 501(C)(3))

File Upload

Drop files here or

Max. file size: 512 MB.

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Community Health Grant Application