Statement of Interest Guidelines



APPLICATION PART II – NON-GOVERNEMENT ENTITIES

STATEMENT OF INTEREST

TEMPLATE

Please provide the information requested below with respect to the proposed project.

a. Describe the proposed project and major project activities that will take place during the project period.

b. Explain how the project fulfills one or more of the three project categories outlined in Section IV of the Invitation to Apply.

c. Describe your goals in undertaking the project and what you hope to achieve.

d. Briefly define the target community the project will serve and, if actual data or reasonable estimates can be secured, indicate the number of people the project will serve.

i. Note whether you have worked with the target community before and whether it has been involved in the development of the project.

ii. Describe any underserved groups or areas that will be served by the project.

e. Describe the importance of the project at this time and how it will be of value to the community served.

f. Describe the relationship of the project to the local government and the existing and/or desired local government support for and involvement in the project.

g. Provide a schedule of key project milestone dates by month or quarter. (May be attached as a separate page.)

h. Budget. State the amount you are requesting ($25,000, $50,000, $100,000, $200,000, or $250,000) and provide an outline of the total project budget. Be sure to include the 1-to-1 nonfederal match funds in the total project budget. (Budget may be attached as a separate page.)

i. Briefly describe how funds will be used.

ii. Describe the source(s) of the nonfederal match and timing of funding commitments.

iii. Provide the amount of the overall budget for the project, if different from the amount requested.

i. Describe the partners, key organizations and individuals that will be involved in the project, including any artists, design professionals or other individuals, nonprofit or commercial organizations. Indicate whether they are committed to the project or merely proposed at this time. For projects involving multiple organizations, indicate which one is the official applicant.

i. Describe the responsibilities of any partners and the resources each will provide.

ii. Describe the involvement of any partners in the development of the project to date, if applicable.

iii. Describe the process and criteria used (or planned to be used) for the selection of any partners, key organizations and individuals involved in the project.

j. Describe plans for promoting, publicizing, and/or disseminating the proposed project, as applicable.

k. Describe plans for monitoring the project and assessing the degree to which you achieve the goals outlined in (c) above.

i. Describe how you will measure success in achieving the goals.

ii. Include plans for documentation, evaluation and dissemination of results, as appropriate.

iii. If this is an ongoing project, state the results to date, the rationale for continuing the project and evidence of impacts achieved for the community. Include any social, cultural and/or economic impact data collected and analyzed, if any.

APPLICATION PART II – NON-GOVERNEMENT ENTITIES

ORGANIZATIONAL INFORMATION

TEMPLATE

Please provide the information requested below with respect to the applicant’s organizational, financial and management capacity. For projects involving multiple organizations, information should be provided for the official applicant organization.

a. Mission statement.

b. Information from your most recently completed fiscal year financial statement.

|Fiscal Year | |

|Total Earned Income | |

|Total Unearned Income* | |

| Corporate Contributions | |

| Foundation Grants | |

| Government Grants | |

| Individual Contributions | |

| Other Unearned | |

|Total Expenses | |

|Operating Surplus/(Deficit) | |

* Funds raised toward capital projects should not be included.

c. Plans for staffing, implementation and supervision of the project.

d. Previous experience designing, implementing and managing similar projects.

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