Download sample application for small grants, etc

Small Grant Guidelines and Instructions for Applicants
2013-2014
The Idaho Affiliate of Susan G. Komen for the Cure® —along with those who generously support us with their talent,
time and resources—are working to better the lives of those facing breast cancers in our community. We join more
than 100,000 breast cancer survivors and activists around the globe as part of the world’s largest and most progressive
grassroots network fighting breast cancer. Through events like the Boise Race for the Cure and the Coeur d’Alene Race
for the Cure, we have invested over $5.1 million in local breast health and breast cancer awareness projects in 28
counties. Up to 75 percent of net proceeds generated by the Komen Idaho Affiliate stay in Idaho, the remaining income
goes to the national Susan G. Komen for the Cure Research programs for energizing science to find cures.
Applications will be accepted for breast health supporting projects relating to education, travel or breast health
conferences. Programs must be relevant to our 28 counties in North, Central and Southwest Idaho including, Ada,
Adams, Benewah, Blaine, Boise, Bonner, Boundary, Camas, Canyon, Cassia, Clearwater, Elmore, Gem, Gooding, Idaho,
Jerome, Kootenai, Latah, Lewis, Lincoln, Minidoka, Nez Perce, Owyhee, Payette, Shoshone, Twin Falls, Valley, and
Washington.
Important Dates
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Small Grants Applications are accepted throughout the year. However, requests for support of
travel scholarships, conferences, or other events must be received at least six weeks prior to the
event.
Final written report due 30 days after event/travel concluded. Please explain progress/activities
that were made toward reaching the goals/objectives from the original application including the
number of people served by Komen grant funding.
Eligibility and Funding:
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Only funding requests which meet the following criteria will be considered for a small grant:
Specific to breast health/breast cancer
Relevant to the Komen Mission to eradicate breast cancer as a life threatening disease by advancing
research, education, screening and treatment.
Will the program have a substantial positive impact on breast cancer disparities in the priority area
selected
Applicant has demonstrated that there is a significant need for this project
Willingness to acknowledge support of Komen Idaho Affiliate
Activity relevant in the Komen Idaho 28 county service area.
Report finances and progress to the Affiliate; final report with receipts much be attached.
Allow participation of Affiliate representative where appropriate (education materials, promotional
items, and/or guest speakers are available through local Affiliate; other purchases of these items
may not be paid with Komen grant.)
Not for a fundraising activity
Applicants must be a US nonprofit (federally tax-exempt) organization, e.g. nonprofit organizations,
educational institutions, government agencies and Indian tribes are eligible.
Small grants applicants are restricted a maximum combined award of $5,000 per calendar year, per
program, for any type or combination of small grants and/or applicants are limited to two small
grant applications per year.
Educational Grant
Small grants are intended to support some of the “unexpected” costs associated with a project. Funding
request for education project must be for $2,500 or less.
Allowable Expenses - Funds may be used for the following types of program expenses:
 Educational materials (please check with Komen for possible educational materials)
 Meeting Costs (food costs for presentation)
 Supplies
 Travel
 Other direct program expenses
 Equipment for educational purposes
Funds may NOT be used for the following purposes:
 Salaries and fringe benefits
 Clinical services or patient care costs (ie. Mammography, ultrasound, etc.)
 Medical equipment
 Medical or scientific research
 Scholarships or fellowships
 Construction or renovation of facilities
 Development of materials (design, printing costs, etc.)
 Political campaigns or lobbying
All applications must include all items listed below and should be presented in the same order:
1. Completed application page, (attached)
2. Narrative including the following (2 page maximum):
a. Purpose of funding request
b. Project goals and objectives
c. Benefit to Komen Affiliate
d. Timeline
e. Other participating sponsors or organizations
3. Detailed budget and budget justification
4. Proof of non-profit status
Conference Grant
Conference Grants are intended to support local scientific or educational conferences, symposia and
meetings, with an emphasis on those that enhance the interaction between the advocate, healthcare and
scientific communities.
Only funding requests which meet the following criteria will be considered for conference sponsorship,
 Specific to breast health or to help further the body of knowledge related to research, diagnosis,
treatment, education, and/or other issues related to breast cancer
 Acknowledgement of support from Komen Affiliate in all printed materials (please ask for current
logo package before printing)
 Participation of Affiliate representatives where appropriate
 Funding request is $2500 or less and cannot be used to fund salaries.
 Complimentary registration for at least two (2) Affiliate representatives
 Display area where appropriate
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Activity report following conference that includes number of participants, copy of conference
materials, evaluation of program, and impact of Affiliate sponsorship and participation (due within
20 days of conference)
All applications must include all items listed below and should be presented in the same order:
1. Completed application page, (attached)
2. Narrative including the following (2 page maximum):
a) Conference program outline
b) Target audience and number expected to attend
c) Specific sponsorship opportunities (i.e., representation of the Affiliate at events, on panels
or as speakers, where appropriate; complementary registration provided for at least two (2)
Affiliate representatives; exhibit space in visible, conspicuous location)
3. Proof of non-profit status for applicant institution. To document your federal tax-exempt status,
please attach a copy of your determination letter in full from the Internal Revenue Service, must
include EIN number. Evidence of state or local exemption will not be accepted.
4. Detailed event budget and budget justification
Travel Scholarship
The purpose of this funding opportunity is to provide travel assistance to grantees, health care professionals
and advocates to attend, participate in, and/or present at meetings, conferences, or symposia that would
increase the community knowledge of breast health and breast cancer to facilitate the exchange of ideas
and communication between the scientific and lay public.
Only funding requests which meet the following criteria will be considered for a travel scholarship:
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Conference is relevant to breast cancer as demonstrated by agenda, etc.
Funding request is less than $1,000 domestic or $2,500 international (to include registration, coach
airfare/train/mileage, moderate hotel [room and taxes only], meals, cab fare and tips)
 Applicant is able to quantify participation and benefit to community
 Applicant must attend majority of conference and apply for the continuing education credits offered
All applications must include the items listed below and should be presented in the same order:
1. Completed application page, (attached)
2. Narrative including the following (2 page maximum):
a) Conference goals and/or program outline
b) Statement of how program is relevant to breast health
c) Specifics of participation and benefit to traveler describing ability and intention of traveler
to spread information to Komen Affiliate service area
3. A letters of recommendation, from the employer, if applicable
4. Detailed budget and justification; all receipts must be turned in with detail
Questions? Please contact: Susan G. Komen for the Cure, Idaho Affiliate
1409 W. Main, Ste. 120
Boise, ID 83702
(208) 384-0013
[email protected]
Application for Small grants: Educational Grants, Conference Grants, and
Travel scholarships
Idaho Affiliate
Small Grant Application
Project Director & Title
Institute
Address
Phone (
)
Fax (
)
Email
TAX ID NUMBER (EIN)
A COPY MUST BE ATTACHED
Title of Project/Conference
Please attach conference
schedule/sessions
Total Amount Requested
Signature & Title of
Approving Personnel
(other than Program Director)
Name & Title of Approving
Institutional Personnel (typed)
Educational Grant
Date
Conference Grant
Travel Scholarship
Please submit with required documents, no staples.
Please allow for a 30 day review period.
Final Reports for all Small Grants are due within
30 days of completion of your project.
Return info to: 1409 W. Main, Ste. 120
Boise, ID 83702
Fax: 208-384-0014
Email: [email protected]