HEALTH AND WELLNESS FOUNDATION OF PIKECOUNTY
112 W. Washington Street PO Box 81 Pittsfield, IL62363
Phone 217.285.6080 Fax 217.285.6082
IMMEDIATE RESPONSE GRANT (IRG)
2012 FUNDING GUIDELINES
The Health and Wellness Foundation of Pike County(HWFPC) was incorporated to support and help improve the health and wellness of individuals seeking health care in Pike County, IL and as such will only fund qualifying organization and agencies that directly benefit the residents of and those seeking health services within PikeCounty.
Areas of Interest
Immediate Response Grants (IRG) are awarded for programs that do not fit withinHWFPC’s Healthy Communities Grant Program cycle. The IRG may be awarded to any qualifying non-profit organization for health, wellness and human service programs benefiting PikeCounty. Immediate Response Grants fund projects in amounts up to and not exceeding $3500.00 in a twelve month period. HWFPC will accept Proposals for new or existing projects that fit their standard funding criteria.
Proposal Evaluation Criteria
All proposals submitted to HWFPC that adhere to the qualifying conditions will be taken into consideration. Proposals will be judged on their ability to meet the Foundation's funding objectives within their mission focus. HWFPC favors projects that:
- Establish new and sustainable ways to address health problems
- Demonstrate broad positive impact on the community
- Exhibit a high level of collaboration between agencies and service providers
- Reach underserved populations
- Reduce long-term expenses or duplication of services
- Leverage supplemental funding sources
- Incorporate sound programmatic approaches and evaluation methods as building blocks for long-term program success
- Create lasting value
Eligibility
HWFPC only supports organizations that are consistent with and complementary to the mission and charitable, tax-exempt purposes of HWFPC. Grants will not be made to individuals, churches, governmental agencies, or private providers. Grants are restricted to organizations and programs that directly benefit the PikeCounty population and those seeking health services within PikeCounty. Under its tax-exempt status, HWFPC will not fund organizations that directly or indirectly participate in political campaigns on behalf of candidates for political office.
HEALTH AND WELLNESS FOUNDATION OF PIKECOUNTY
112 W. Washington Street PO Box 81 Pittsfield, IL62363
Phone 217.285.6080 Fax 217.285.6082
Instructions
Please provide one complete original and one complete copy of the proposal, totaling two complete applications, and include two copies of all attachments.
To Qualify for Consideration, Grant Proposals must be:
Inclusive of ALL required information detailed within this document.
Typed on 8 1/2" x 11" paper, double spaced, 12 pt. font
Printed on one side with the organization's name and page number on each sheet
No more than eight typewritten pages, plus attachments. Video tapes or other materials not specifically requested will not be accepted.
Submitted by mail only. Do not attempt to hand-deliver applications to the Foundation office without an appointment. Faxed or Emailed proposals will not be accepted
Stapled or clipped proposal- do not bind
For more information or for questions about any of the information requested in this application, please call the Foundation office at 217-285-6080 or email .
Grant applications should be submitted to:
Patricia McIntosh, Executive Director
Health and Wellness Foundation of PikeCounty
112 W. Washington
PO Box 81
Pittsfield, IL62363
HEALTH AND WELLNESS FOUNDATION OF PIKECOUNTY
112 W. Washington Street PO Box 81 Pittsfield, IL62363
Phone 217.285.6080 Fax 217.285.6082
IMMEDIATE RESPONSE GRANT APPLICATION
I. EXECUTIVE SUMMARY
Provide a one page Executive Summary that includes the following information:
1.Date of application
2.Organization name, address, telephone and fax number, and email address
3.FEIN
4.Contact Person and Project Manager, title and phone number
5.The Project Name
6.Purpose of funding request and brief description of the project
7.Total amount of funding requested from HWFPC
8.Total amount of Project Budget (identify funding requested from HWFPC)
9.Project Time Period (number of months) grant would cover
10.Signatures of Chief Executive Officer and Project Manager
II. PROPOSAL NARRATIVE
A. Overview
1.Provide a brief narrative of the organization's history including mission, overall goals
and/or objectives.
2.Describe the organization's current programs and activities.
3.Describe any formal or informal relationships with other organizations.
B. Purpose of Funding Request
1. Describe the targeted population’s health needs or obstacles that this project will address, and how this will be accomplished
2. Identify strategies to be utilized in the proposed project, including as applicable:
i.Project Goals and desired outcomes
ii.Timetable for accomplishing stated goals and objectives
iii.Names and qualifications of key project staff responsible for project oversight and implementation
iv.If project is collaboration, describe the partners involved and nature of
the collaboration
C. Project Evaluation
1.Describe the evaluation methodology to be utilized in determining if the Project Goals have been met and the desired outcomes Achieved.
2.Name and contact information of person(s) responsible for monitoring and assessing the results of the project
D. Financial
1.Name and contact information of the person who will provide fiscal oversight and fund management for the project.
2.Project Budget, detailing expenses and all sources of income.
3. Applicants current fiscal year Operating Budget
4.Audited financial statements for the most recent full fiscal year, and IRS Form 990.
If neither document is available, include un-audited financial statement.
4. A list of all other grant funding provided in the last fiscal yea
III. REQUIRED ATTACHMENTS
A. Required Supporting Materials
1.Letter of IRS determination indicating tax-exempt status, and federal tax identification number.
2.Final Grantee Report - if a project has been previously funded by HWFPC
3.Current Board of Directors List
4.Most recent Annual Report, if available
5.Letters of support from sponsors and other sources including donors, if applicable
Health and Wellness Foundation of PikeCounty Immediate Response Grant Application –2012 Cycle page 1