Grant Application Form Page 5
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7Ronald McDonald House Charities New York Tri-State Area, Inc.
G
A
F
RANT
PPLICATION
ORM
Page Two
NEW YORK
TRI-STATE AREA
H.
TARGET POPULATION AND PERFORMANCE SITES
Total number of children to be served by THIS grant: ________________________________________
Age(s) of children to be served:
0-3 yrs: _____%
4-8 yrs.: _____%
9-12 yrs.: _____%
13-18 yrs.: _____%
19-21 yrs.: _____%
% of children in specific demographic groups:
_______________ % African American
_______________ % Hispanic- American
_______________ % Native American
_______________ % Caucasian
_______________ % Asian-American /Pacific Islander _______________ % Other
I.
ORGANIZATIONAL BACKGROUND AND SIGNIFICANCE
Briefly describe the background of your organization.
J.
PROJECT OBJECTIVES AND AIMS
Briefly state the broad, long-term objectives of your project, and describe what the program in this
application intends to accomplish.
K.
DESCRIPTION OF PROJECT
Provide a detailed description of the need or problem to be addressed, how your project will
address those needs, the specific purpose of the funds requested, and what is unique about your
project.
L.
FUTURE FUNDING
Describe your plans for funding this project in the future. If other funding sources are already in
place, please include this information.
M.
PREVIOUS FUNDING FROM RMHC
Indicate if your organization have received prior funding from RMHC NYTSA. Please list dates,
amounts and name of projects/programs funded.
N.
EVALUATION
Indicate how your organization will evaluate the program if funded, i.e., survey, questionnaire, test
results, etc.
Revised 07/2012
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