1. GENERAL INFORMATION (all fields required)
Organization’s Name:
Federal Tax ID#:
Mailing Address:
City: / State: / Zip:
Daytime Telephone:
Web Site Address:
Executive Director/ CEO’s Name (check one):
Executive Director/CEO’s E-mail Address:
Organization’s Current Budget: / $
Project/Program Budget: / $
Requested Grant Amount: / $
Contact Name for Grant Application:
Title:
Email Address:
Daytime Telephone:
State the purpose of your proposal/request in no more than two sentences:
II. REQUIRED DOCUMENTATION
Please mail the following documentation to:
The DaytonFoundation
Grants and Programs Department
40 N. Main Street, Suite 500
Dayton, Ohio45423
  1. IRS letter of determination 501 (c)(3)
  2. Names of your organization’s board members, terms of office and compensation, if any.
  3. List of key staff members and your organizational chart.
  4. One example of each of the following (if available):
  5. Annual Report
  6. Organizational brochure
  7. Newsletter
  8. A balance sheet and income statement covering your organization’s most recently
completed fiscal year.

Letter of Intent for the thirdDel Mar Social Innovation Award for

Senior Programming

III. PROJECT SUMMARY
Title of Project/Program:
Please summarize your proposal, including brief, but specific information about the purpose of your proposal, the geographical area served and the timetable for implementation of your project. Strong proposals demonstrate unduplicated, systemic and highly collaborative projects that enhance the quality of life for older adults or address trends affecting the region’s aging population.Your project summary must not exceed 3,000 characters in length (spaces count as characters).
IV. TERMS AND CONDITIONS
Letters of Intent must be submitted only as an e-mail attachment. Required documents must be postmarked on or before midnight of the deadline date, or hand delivered by 5:00 p.m. of the deadline date. Required documentation cannot be faxed or e-mailed. Incomplete or late proposals will not be reviewed during the selection process.
I hereby certify that, to the best of my knowledge, all information presented in connection with this Letter of Intent is accurate. I agree to, and fully understand, this Letter of Intent form, and I have reviewed The Dayton Foundation’s Guidelines for Competitive Grants, and I accept its terms and conditions.
Executive Director/ CEO’s Signature / Date