COMMUNITY LEADERS IMPACT GRANT

APPLICATION

Instructions: All documents should be in Microsoft Word 2003-07 format, and should be saved with your first and last name (eg: “Jane_Smith_resume.doc). Upload all completed documents here.

A complete application shall consist of the following:

1.  Applicant’s current resume

2.  Letter of support from organization CEO/Executive Director: Please submit a letter of support signed by the Executive Director/Chief Executive Officer that 1) supports the applicant’s application, and 2) evidences the organization’s commitment to utilize and incorporate the lessons and skills learned by the applicant into the organization’s operations. Letter of support must be no longer than one page.

3.  Applicant’s Proposal: Proposal shall be no more than three pages long, and shall include the following:

I.  ORGANIZATIONAL BACKGROUND: (no more than 1 page)

1.  Briefly describe the organization’s mission and core programs/services.

2.  Briefly describe the community and/or population the organization serves, including the geographical location(s).

3.  Briefly describe the length and nature of your affiliation with your employer.

4.  Briefly describe your current professional role within the organization.

II.  PROPOSED REQUEST: (no more than 2 pages)

1.  Describe the specific professional development need you are seeking to address.

2.  Please demonstrate how the proposed professional development aligns with the mission and goals of your employer organization, and how it will help you contribute to the overall mission of the organization.

3.  Describe the actual professional development to be obtained, including the skills to be acquired.

4.  Describe the method and plan for securing the professional development, including how you will obtain it (ex: vendor, course, workshop, fellowship, working with an expert/consultant, etc).

5.  Describe how will you plan to sustain the impact of lessons and/or skills learned in the organization’s operations, and how you will engage your colleagues to amplify the impact of your learning?

6.  Please provide a clear timeline for the professional development, including expected start and completion dates.

7.  Please provide us with a detailed budget for the professional development you are seeking.