Name of Organization or Individual:

Name (line 2):

Address:

Address (line 2):

City:

State:

Zip:

Phone:

E-Mail Address:

Please give us one or two sentences summarizing your idea or proposal.

Person at Applying Organization for Willary to Contact:

Total Amount Requested:

Total Budget for the Program:

Total Organizational Budget:

Beginning and Ending Dates for Project:

What other organizations in the area provide a service similar to yours?

By checking this box, you hereby certify that the organization named above currently has tax-exemption
under the Internal Revenue Code Section 501(c)(3) and is classified as "not a private foundation" as defined
under Section 509(a) or 4942(j).

Please submit the following additional items.

1. A proposal no longer than five (5)pages describing the following elements of the proposed idea:

a) The need for the idea

b) Objectives and purposes of the project

• What are your specific short-term, measurable objectives against which you will be able to compare and evaluate actual results at the end of the grant program?

c) Activities to achieve those objectives and purposes

d) Qualifications of the staff of the program

e) Whether your organization plans on providing funds for a portion of this program

f) Location of the program and its duration

g) Please give us one or two paragraphs describing the purpose and history of
the applying organization

h) If you plan to fund this project once the grant has ended, how do you intend
to do it?

i) An evaluation plan to determine the results of the program

Please send the following items by regular mail:

2. An itemized budget no longer than one (1) page identifying the projected expenses and income of the project.

3. An audited financial statement of the eligible institution, including the balance sheet and income statement, if available.

4. A copy of the latest available annual report for the organization.

5. A projected budget for the organization with projected revenues and expenses for the current fiscal year.

 

In the case of individuals or certain organizations and groups, it may be difficult or impossible to submit some of the requested items. If you cannot include one or more of the requested items, please give us a brief explanation. We will try to work with you to develop enough information to satisfy our needs.

It would be useful to the Board of Willary if you included a summary of any analysis or evaluation of the field of work directly related to your project or evaluations of similar projects from the past.

Particular Emphasis for Grant Evaluation

The Board of the Willary Foundation is particularly interested in any unique and innovative facets of your idea. The Board will also pay particular attention to how the program will help the Lackawanna and/or LuzerneCounties' Community. The Board is particularly looking for projects that will have a ripple effect or that act as a pilot program that could be expanded by the community once it is completed and found successful. The grant evaluation process may include site visits and interviews with clients of grantees. Willary reserves the right to request interim reports.

The Willary Foundation Board of Directors meets twice a year to consider, evaluate and approve grants, but requests can be made at any time. We cannot guarantee the consideration of grant applications postmarked later than March 10th for the spring meeting of the Willary Board and no later than August 27th for the winter meeting of the Board.

Grants approved but not expended within one year of approval will be terminated unless a grant extension is approved by the Willary Foundation.

A final evaluation, financial and/or narrative, must be submitted as soon as the funds have been expended but not later than 90 days after the completion of the project. Please answer the following questions at that time:

1. Please tell us succinctly and specifically what you did with your Willary grant money. In cases of grant money issued for a specific program, focus exclusively on that program. In cases of grant money issued for general operating purposes, tell us exactly what you did with the Willary money.

2. Compare and evaluate your specific, short term, measurable objectives as listed in your application with the actual results achieved.

3. How do your actual expenses compare with the budget projections?

4. What were the lasting benefits of your project?

5. What would you do differently if you were starting the project now?

6. Do you have any comments, suggestions or criticisms about working with the Foundation?

7. If you want us to know anything about the program in general, its accomplishments, or character, please do it here.

8. What challenges / barriers to success did you encounter? How did you respond to these challenges?

Normally, grants below $1,000.00 will not be considered. If you are considering asking for a grant in excess of $25,000.00, we suggest you consult our Administrative Director before formulating your application.

Generally, Willary will not consider applications for capital campaigns and annual drives.