Online Grant Application - Eyesight Foundation of Alabama

EyeSight Foundation of Alabama
APPLICATION FOR FUNDING
Deadline: May 1, 2020

SECTION A – ORGANIZATION INFORMATION

Organization Name * AKA * School/Department/Division * Federal Tax ID *

ORGANIZATION ADDRESS

Mailing Address * Street Address Campus Address Phone * Fax Email * Website

ORGANIZATION PRIMARY CONTACT (CEO, President, Dean, Department Chair, etc.)

Organization Primary Contact Name * Organization Primary Contact Job Title * Organization Primary Contact Address * Organization Primary Contact Email * Organization Primary Contact Phone *

PROJECT PRIMARY CONTACT (The person most familiar with the project, our first point of contact)

Project Primary Contact Name * Project Primary Contact Title * Project Primary Contact Address * Project Primary Contact Email * Project Primary Contact Phone *

PROJECT INFORMATION

Total Project Budget * Amount Requested of the Eyesight Foundation of Alabama through this application * Project Title * Project Description * Select *

SECTION B: PROJECT BUDGET FORM

If your project is funded, you will use this same worksheet to report actual expenses and to explain any significant variances at the end of the funding period.

If you are part of UAB: use accepted Contracts and Grants Accounting classifications/terminology. If filling in this budget form or complying with any other application requirement shifts your project into UAB Contracts and Grants/Sponsored Research, and you would prefer your project be treated as a Gift instead of a Grant, please contact our office to discuss potential modifications to support that goal.

Download the form Here — email the Form and any additional necessary documents to torrey@uab.edu. Your subject line should be Grant Application and your project name

SECTION C – NEW REQUEST APPLICATION

1. Organization Background: Mission, history, major programs, accomplishments, collaborations with other organizations. 2. Project or Program: Specific eye care need or issue you will address; goals and objectives; activities that will be carried out to accomplish the objectives; key personnel and their qualifications; other organizations involved in your project; other organizations providing similar services. 3. Project Evaluation: your criteria for effectiveness; the methods you will use to analyze your results (measure your progress); who will assess the results? 4. Project Continuation: if the project is ongoing, list and describe your plans to continue beyond this funding period – donations from individuals, grants from foundations and other funding sources, earned income, insurance reimbursements, etc. 5. Additional Funding: List other foundations or sources to which you have submitted a proposal for this project, with the amount and status of each request – approved, declined, or pending. 6. Factors that May Influence Funding: Are there internal or external issues that may affect your project and/or organization’s funding or financial position, such as the economy, changes in healthcare reimbursements/coverage/laws, a shift in mission or focus, or challenges within the organization? Help the EyeSight Foundation understand special circumstances or challenges that you face. 7. References: If your organization has never received funding from ESFA, list three professionals familiar with the work of your organization.

SUPPORTING DOCUMENTATION AND AUTHORIZATION

Not required of UAB Applicants. All others requesting new funding must provide the following by email to torrey@uab.edu. Your subject line should be Grant Application and your project name:
• Current operating budget
• Income and expense statement for last fiscal year
• A tax return or audited financial statement
• A list of current Board of Directors, including affiliation of each member
• Tax-exempt letter from the IRS

SECTION D –CONTINUATION REQUEST APPLICATION
STEWARDSHIP REPORT ON PRIOR FUNDING

The following information assists us in measuring the achievements of the projects we support. We ask for your honest, critical attention in completing this report. We are interested in what qualities contributed to the successful aspects of your project, as well as reasons that made other goals more difficult or impossible to achieve. This report should help you assess your accomplishments, evaluate your work and point to ways to improve a project. Your answers need not be lengthy; a short response is adequate and preferred.

1. List the original goals and objectives of the funded project, and tell how they have been met during this reporting period with funds received from The EyeSight Foundation of Alabama. If applicable, describe the current status towards meeting any special terms or conditions of this award. 2. What impact did this project have on the people or community you served during the award period? Did you reach the population you originally targeted? Use measurable indicators (numbers, percentages, etc.) 3. List any changes in your organization that have occurred since you received the award (leadership, personnel, mission, funding, etc.). As we become very familiar with the projects we fund, we require less paperwork for renewals, but it is your responsibility and duty to inform us of any changes and how those changes might affect your project. 4. We recognize that variance from original project plans often occur. In what ways did the actual project vary from your initial plans? List any changes to the budget, the scope of the project, collaborators, etc. Describe how and why. Message 5. Were there any unanticipated results, either positive or negative? What did you learn because of this? 6. Will you make any adjustments based on these changes, variances or results as described above in questions 3, 4 or 5? 7. Did you receive funding from other sources for this project? If so, from who and how much? What is your progress toward securing funding to sustain this project in the future? 8. Factors that May Influence Funding: Are there internal or external issues that may affect your project and/or organization’s funding or financial position, such as the economy, changes in healthcare reimbursements/coverage/laws, a shift in mission or focus, or challenges within the organization? Help the EyeSight Foundation understand special circumstances or challenges that you face. 9. Did any collaborative/cooperative efforts with individuals and organizations proceed as planned? 10. Are there any other important outcomes as a result of this award? 11. Have you or will you share your results or findings? How? 12. Have you acknowledged the source of this funding? Please provide copies of printed recognition, as appropriate. 13. Feel free to share comments, recommendations or feedback. You may attach additional pages.