Fill and Sign the Alexander Purchase Agreement Improved Property Prudential Form

The Schwartz Center for Compassionate Healthcare GRANT APPLICATION Please type and answer all questions in full. 1. Please provide a three-paragraph executive summary of your proposal, including amount requested, brief project description, why it is needed, and your organization’s expertise in this area. (You will be asked to provide more detail below.) 2. Have you previously applied for Schwartz Center funding? If so, please indicate date(s). Yes___________ 3. Year(s): __________ No___________ Have you previously received Schwartz Center funding? If so, please indicate date(s) and amount of grant(s). Date(s)________________________ Amount(s)________________________________ 4. Applicant name, primary address, telephone number and e-mail address. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 5. Do you operate under any other name(s) or at any other location(s)? ________________________________________________________ ________________________________________________________ 6. Name(s) and title(s) of the manager or director of the proposed project. ________________________________________________________ ________________________________________________________ 7. Name, address, telephone number, and e-mail address of at least one other contact person for the proposed project: ________________________________________________________ ________________________________________________________ ________________________________________________________ 8. Please attach answers to the following questions, using a total of five or fewer doublespaced typewritten pages. a. What is your organization’s mission or primary purpose? b. Please describe the project for which funding is requested, and how it aligns with the Schwartz Center Grants program philosophy. c. What need is the project addressing, and how has that need become apparent? d. What are the project’s overall goals and specific objectives? e. Outline the specific steps you’ll take to implement the project, with estimated timeline. f. How will you evaluate whether you have accomplished your goals and specific objectives? Please include any assessment instruments you have developed for this purpose. g. How will other organizations learn about the project’s successes? h. Provide an itemized budget and budget justification for the project, including amounts you propose to cover from sources other that the Schwartz Center Grants program. Indicate other sources of funds that have been received or requested to date. i. How does this project fit into your organization’s long-term plans? How will it be sustained after the duration of the grant? 2 9. Submit a copy of your organization’s overall budget for the current fiscal year and your organization’s most recent audited financial statement, if available. 10. Attach a copy of your most recent section 501(c)(3) tax exempt notification letter from the Internal Revenue Service. 11. Please submit any letters of support for your proposed project. Letters of support are encouraged. 12. Please include copies of brochures, news clips, leaflets, or other materials that will help the Schwartz Center understand your organization and the activities for which funding is requested. 13. Please attach the CV of the project director(s). All of the information supplied above by the applicant is true and correct. I have read and understood the Schwartz Center’s eligibility requirements and determined that _______________________________________ (name of applicant) is eligible under them. Certified by: ____________________________________________________ (Signature) ____________________________________________________ (Title) ____________________________________________________ (Date) 3