Research and Education Grant Application

Organization Profile

Organization Name*

Address*

Street Address Address Line 2 City State ZIP Code

Website*

Organization Phone Number*

DBA/Alternate Name of Organization

Federal UEI*

EIN*

Is the Organization Tax Exempt?*

Yes

No

Your organization is not eligible for West Cancer Foundation funding. Please consider reapplying if your status changes. Return to our home page.

Primary Contact

Name*

First Last

Title*

Phone Number*

Mobile Phone*

Email Address*

Secondary Contact

Name

First Last

Title

Phone Number

Mobile Phone

Email Address

Application

Project Title*

Project Purpose*

Amount Requested*

Please enter a number greater than or equal to $1.

Please enter a number greater than or equal to 1.

Proposal Narrative

Executive Summary*

Present the key points of your proposal and describe the relevance of your request. Discuss project alignment with West Cancer Foundation's mission and priorities.

Organizational History and Purpose*

Tell us about the organization's history, mission, structure, staff size, principal activities and major accomplishments. Who are your partners and how do they support the proposed work? Why is your organization a candidate for funding?

Statement of Need*

Please identify the needs addressed in this request. Substantiate your case using pertinent data. Source references will be requested as an attached document.

Program Description*

Describe the project and its activities. What is the predicted impact of the project, short and long-term? Outline the strategy/methodology and timeline for developing and implementing the project. Document the size and characteristics of the target population. How does the project enhance or support existing services? List the project goals and measurable objectives. Briefly describe the evaluation process for the project and the use of results. Who are the key personnel in the project and what are their qualifications?

Please provide the following proposal attachments.

Proposal Narrative References*

Attach appropriate citations for data sources referenced in the proposal (MLA and APA styles are acceptable)

Max. file size: 50 MB.

Detailed Project Budget*

Present a table of all revenue and expenses associated with the project.

Max. file size: 50 MB.

Project Budget Narrative*

Expense - Describe each cost by line item and the calculation by which it was determined.

Revenue – List all sources of cash and in-kind, including status (pending or secured) and specific purpose, if applicable. What percentage of the organization’s budget is requested through this application?

Max. file size: 50 MB.

CV or Bios of all key personnel*

Drop files here or

Max. file size: 50 MB.

Letters of Support for the project*

(minimum of 2)

Drop files here or

Max. file size: 50 MB.

IRS Letter of Determination or other issued confirmation of exemption status.*

Max. file size: 50 MB.

Organization Budget*

Current and projected fiscal years with explanations of any deficits