Get Coverys Community Healthcare Foundation Grant Request Form

This guide provides a clear, step-by-step approach to completing the Coverys Community Healthcare Foundation Grant Request Form online. By following these instructions, users can ensure a thorough and accurate submission of their grant request.

Follow the steps to effectively complete your grant request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of application in the designated space.
3. Fill in the legal name of your organization and provide the address and website.
4. Include a phone number with area code for your organization.
5. Indicate if your organization is an IRS 501(c)(3) nonprofit by checking the appropriate box. If applicable, provide your EIN number.
6. If your organization is not a 501(c)(3), specify your type of legal entity and tax status.
7. Document the year your organization was established.
8. Enter the name of your President or Executive Director along with their email address and phone number.
9. If there is a different contact person, provide their name, title, email address, and phone number.
10. Input your organization’s total annual budget and indicate the end date of your fiscal year.
11. List the total number of board members and staff at your organization.
12. Provide the names of board members as requested.
13. Write your organizational mission statement.
14. Briefly describe your organization, including the population served and geographic reach.
15. Fill out the description of your proposal, including the project/program name and the amount requested.
16. Document the total project budget and indicate the grant period.
17. Summarize how the proposal aligns strategically with the Coverys Community Healthcare Foundation.
18. List the target population and geographic area your proposal aims to serve.
19. Indicate if your organization is a United Way affiliate.
20. If applicable, list any support received from the Coverys Community Healthcare Foundation in the last five years.
21. Provide a detailed profile of your organization, including history, goals, and services.
22. Describe the program/project, its goals, and the challenges it addresses.
23. Outline the evaluation criteria and process for measuring success.
24. Complete the attestation, affirming the usage of grant funds and non-discrimination.
25. Attach required documents such as IRS letters, financial information, and personnel backgrounds.
26. Once all fields are completed, save your changes and download, print, or share the form as needed.

Complete your grant request form online today to ensure your application is submitted promptly.