RESIST, 259 ELM STREET, SUITE 201, SOMERVILLE, MA 02144 MULTI-YEAR GRANT APPLICATION FORM ___________________________________________________________________________________ This box for Resist staff use only. Date Received ________________ Board Meeting Date ________________ Board Decision ________________ ___________________________________________________________________________________ Grant applicant please provide the following information: Date ___________________ Name of Organization __________________________________________________ Address _______________________________________________________________ _________________________________ Telephone (____)_____________________ E-mail address __________________ Web Site ____________________________ Contact Person___________________ Phone (if different)_________________ Is your group tax-exempt? ______ Yes ______ No If yes, please attach a copy of your Federal IRS notification letter. Neither your state tax exemption nor your employer identification number meet this requirement. If you are not tax exempt, do you have a tax-exempt organization that will supervise the funds you would receive if your proposal is approved? ________ If so, please fill in the name and address of that organization below and attach their IRS notification letter with this application. _______________________________________________________________________ Please list any projects for which you have applied to RESIST in the past. Include projects for which you applied to RESIST but did not receive funding. If your organization applied under a different name, list that below as well. Application Date Project Description Award Amount _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ How did you hear about Resist? ________________________________________ [End of page 1] Multi-Year Request for Funding: 1. Amount requested: $3,000 per year for three years 2. Please provide a one sentence description of your organization. HISTORY 3. Briefly describe the history of your organization. $ When, why, and by whom was it started? $ If applicable, how has your organization changed over the years? VISION 4. Briefly describe your organization's vision of social change and how you work to realize that vision. $ If applicable, discuss how the ongoing work of your organization responds to and addresses US domestic policy and/or US foreign policy. PROGRAM 5. How does your proposed work help build a powerful and lasting grassroots movement to deal with the root causes of the problem that your organization addresses? Please indicate: $ the goals of your project or organization; $ your plan to achieve these goals, including a timeline; and $ how you will evaluate the effectiveness of your efforts. 6. What have been your organization=s most significant accomplishments and challenges over the last three years? 7. What other events and/or projects is your group planning over the next three years? ORGANIZATIONAL STRUCTURE AND COMPOSITION 8. Briefly describe how your group operates in terms of: $ who makes decisions and sets priorities for your organization; $ the responsibilities of the board, staff and members; $ the number of members you have; $ your strategies to recruit new members; and $ the number of paid staff. 9. Please use the attached chart to illustrate the make-up/diversity of your group=s Board, Staff, Volunteers and Members in terms of age, race, sexual orientation, class, physical ability and gender. $ How have you taken steps to increase that diversity? FISCAL MANAGEMENT/FUNDING SOURCES 10. Does your organization have the internal capacity and systems to sustain itself as a strong, lasting organization? Please discuss your fiscal management and your fundraising goals. Please attach : o your most recent completed financial statements; and o your current annual budget showing your income and expenses. If you do not prepare organizational budgets, you may use the form enclosed with the application. 11. Please list all other foundations you have applied to in the past three years and the results of those applications. Are you currently applying to other foundations for this or another project? If so, please indicate which foundations and whether the request is pending, secured or turned down. POLITICAL FOCUS RESIST believes that building an effective movement for social change requires groups to discuss issues that may not be central to their organization or work. RESIST funds organizations that can demonstrate an understanding of the important connections within the broad spectrum of issues that progressive activists struggle to address. As part of the application process, RESIST seeks an honest evaluation from organizations about their position, or lack of a position, on issues of race, class, gender, reproductive rights, lesbian and gay rights, age and disability. Your answers to the following question will enable us to get a better sense of the focus and perspective of your group. 12. Please provide specific information that illustrates the: 1) programs, 2) coalition work, and 3) position of your group in relationship to the rights and concerns of each of the following: a) people of color b) working class and poor people c) women (include your group's position on reproductive and abortion rights) d) gay/lesbian/bisexual/transgender rights and liberation e) people with disabilities f) older people g) youth COLLABORATION 13. How does your organization collaborate with other organizations? o Please describe groups or coalitions you currently work with or have worked with in the past. o Are there other organizations in your community that do similar work? o If so, how do your organizations cooperate with each other? o What work do you do that crosses issues and constituencies? REFERENCES Please provide the name, organizational affiliation, address, e-mail and phone numbers of three people we can contact as references. Include people who are familiar with your work but who are not members of your group. 1.___________________________________________________________________________________ 2.___________________________________________________________________________________ 3.___________________________________________________________________________________ ATTACHMENTS Please include the following items with your proposal: * Your most recent completed financial statement, your current annual budget and a project budget (if applicable) showing your income and expenses. If you do not prepare organizational or project budgets, you may use the form enclosed with the application. * If you are requesting a grant for printed materials (e.g. a newsletter or brochure), please include a copy or draft. * If you are requesting funding for a play, radio, film or video project, please send a script or a copy of the production. GRANT APPLICATION CHECKLIST Please enclose each of the following materials with your request. Incomplete applications will not be considered. If you have any questions regarding the application, please call the RESIST office for assistance. * Cover Letter * Cover Sheet * Grant Application Form (one copy) * Multi-Year Grant Application Form, if applicable (one copy) * IRS 501(c)(3) Notification Letter (or IRS letter from sponsoring organization/ fiscal conduit) * Last Complete Financial Statement (your income and expenses for your last fiscal year) * Projected Budget for Current Fiscal Year (including a breakdown of income and expenses) * Three references (including name, address, organizational affiliation, e-mail and phone number) * Supporting printed materials (up to three items) * Samples of literature (actual or draft) * A copy of a film, video, radio or slide show for media support requests * Evidence of Past Performance (e.g. prior progress or annual reports, if applicable) * Diversity Chart APPLICATION PROCEDURES: * Applications must be received by 5 p.m. on the day of the proposal deadline * Applications may not be submitted by fax or e-mail * Binders, paper clips or folders are not necessary Please remember that RESIST does NOT fund any of the following: * social service or research projects; * legal defense costs or lawsuit projects; * material aid campaigns; * tours, trips, or travel expenses; * individuals; * projects located outside the United States; * the development or production of films, videos, or radio projects; * publications, media, or cultural projects not directly connected to a progressive organizing campaign; * capital campaigns, capital projects, or endowments; * organizations with access to traditional sources of funding; * other foundations or grant-giving organizations; and * organizations with annual budgets over $125,000. RESIST, 259 ELM STREET, SUITE 201, SOMERVILLE, MA 02144 (617) 623-5110; resistinc@igc.apc.org. ___________________________________________________________________________________ BUDGETS If you prepare organizational or project budgets, you may submit them in their original forms. NOTES 1. If your request is for a special project, complete the project budget form. If your request is for general support, you do not have to complete the project budget form. 2. If your organizational budget is over $125,000, you are not eligible for Resist funding. If it is close to $125,000, you should contact Resist before applying. FINANCIAL STATEMENT (Last Year's Actual Income/Expenditures) Fiscal Year-End Date: ___________ INCOME Resist Request ______________________ Individual Contributions ______________________ Foundation Grants ______________________ Government Contracts ______________________ Membership Dues ______________________ Special Events/Sales Income ______________________ In-Kind Contributions ______________________ Other ______________________ Total Income ______________________ EXPENSES Salaries ______________________ Benefits ______________________ Professional Fees ______________________ Occupancy (rent, utilities) ______________________ Insurance ______________________ Telephone ______________________ Postage/Shipping ______________________ Copying/Printing ______________________ Supplies ______________________ Major Equipment ______________________ Travel/Transportation ______________________ Fundraising ______________________ Promotion/Publicity/Outreach ______________________ Training/Technical Assistance ______________________ Other ______________________ Total Expenses ______________________ BALANCE ______________________ _________________________________________________________________________________________________ ANNUAL BUDGET (Current Year) Fiscal Year-End Date: ___________ INCOME Resist Request ______________________ Individual Contributions ______________________ Foundation Grants ______________________ Government Contracts ______________________ Membership Dues ______________________ Special Events/Sales Income ______________________ In-Kind Contributions ______________________ Other ______________________ Total Income ______________________ EXPENSES Salaries ______________________ Benefits _____________________ Professional Fees ______________________ Occupancy (rent, utilities) ______________________ Insurance ______________________ Telephone ______________________ Postage/Shipping ______________________ Copying/Printing ______________________ Supplies ______________________ Major Equipment ______________________ Travel/Transportation ______________________ Fundraising ______________________ Promotion/Publicity/Outreach ______________________ Training/Technical Assistance ______________________ Other ______________________ Total Expenses (see note 2) ______________________ BALANCE ______________________ _________________________________________________________________________________________________ PROJECT BUDGET (See Note 1) INCOME Resist Request ______________________ Individual Contributions ______________________ Foundation Grants ______________________ Government Contracts ______________________ Membership Dues ______________________ Special Events/Sales Income ______________________ In-Kind Contributions ______________________ Other ______________________ Total Income ______________________ EXPENSES Salaries ______________________ Benefits ______________________ Professional Fees ______________________ Occupancy (rent, utilities) ______________________ Insurance ______________________ Telephone ______________________ Postage/Shipping ______________________ Copying/Printing ______________________ Supplies ______________________ Major Equipment ______________________ Travel/Transportation ______________________ Fundraising ______________________ Promotion/Publicity/Outreach ______________________ Training/Technical Assistance ______________________ Other ______________________ Total Expenses ______________________ BALANCE ______________________ LOBBYING Within the proposed project budget, we estimate that no more than $______________ will be spent for lobbying activity, of which no more than $__________________will be spent for grassroots lobbying, as those terms are defined in the Internal Revenue Service Regulations under 501 (h). ____________________________________________________________________________________________ ORGANIZATIONAL DIVERSITY CHART (Please indicate the number of individuals who fall within the following categories) Board Staff Active Members Members Volunteers ____________________________________________________________________________________________ Total Number ____________________________________________________________________________________________ DIVERSITY BY RACE/ETHNICITY African American ___________________________________________________ Asian Pacific Islander ___________________________________________________ European-American/Caucasian ___________________________________________________ Latina/Latino/Hispanic ___________________________________________________ Multi-Racial/Mixed Heritage ___________________________________________________ Native American ___________________________________________________ Other ___________________________________________________ ____________________________________________________________________________________________ DIVERSITY BY GENDER Female ___________________________________________________ Male ___________________________________________________ Transgender ___________________________________________________ ____________________________________________________________________________________________ DIVERSITY BY AGE Individuals Age 65 and Older ___________________________________________________ Individuals Age 21 and Younger ___________________________________________________ _____________________________________________________________________________________________ OTHER DIVERSITY CHARACTERISTICS Low-income ___________________________________________________ Gay/Lesbian/Bisexual ___________________________________________________ People with Disabilities ___________________________________________________ _____________________________________________________________________________________________ OTHER DIVERSITY CATEGORIES IMPORTANT TO YOUR ORGANIZATION (PLEASE NAME) 1.____________________________ ___________________________________________________ 2.____________________________ ___________________________________________________ 3.____________________________ ___________________________________________________ 4.____________________________ ___________________________________________________ Copyright Resist, Inc., 2003