The Laurel Foundation

Grant Application Form

Your Name *

Phone Number *

E-mail Address *

Name of Project *

Project Contact Person *

Project Information *

Goal Overall Purpose

Objectives

Specific measurable statements of what will be achieved through the project benefiting persons with Mental Health or Autism Spectrum

How is the project innovative?

Describe how the project meets the Measures (as defined) by answering the questions found after each definition. New and unique ways to meet an emerging/changing issue or need.

How is the project responding to a community need?

Responsive: Meets an identified community need/issue

What strategies will you implement to ensure that the project is inclusive, that it is made available to all who want to participate?

Inclusive: Is available to all segments of the community

What may limit access to the project? What will you do to remove these barriers? How does this promote equal access to services?

Accessible: Promotes equal access to services

Who are your partners in this project? Please list the names and phone numbers of your confirmed partners and state how they are involved in this project.

Collaborative: Is developed and delivered with other agencies, community groups, and individuals.

Describe the processes and outcome measures you will use to evaluate the project.

Effective/Efficient: Planning is inclusive of stakeholders; measures are developed; evaluation process is implemented.

Budget

Itemize all project costs and all requested sources of revenue, including your agency's and "in kind" contributions.

All Project Costs

Or upload an excel spreadsheet of all of your itemized costs. Include line items of each cost, the total amount $, Request to Laurel Foundation, Requests to Others, and if from others how much has been confirmed. Only .xls file types supported.

Attach your Activity Plan

Specific action steps to meet objective and corresponding timeline. Accepted file formats are PDF and DOC.