APPLICATION FORM–PART 1 OF 2 2 Due Date: July 25, 2016

Please be advised that this Checklist forms part of your application to ABACUS. In order for your application to go forward, this form must be completed and signed.

All Applicants:

TWO complete copies of the application (including TWO copies all supporting

documentation of the organization holding charitable status

TWO copies of the project budget

TWO copies of your latest annual report and/or general information brochure

For both applicant and sponsoring organization (if applicable)

Indication of approval of Ethics Committee, if applicable, of the organization holding

charitable status

If you are a Community Organization also add:

Signature of the Chair of the Board of Directors and the Executive Director indicating

Authorization of the application by the Board of Directors of the organization holding

charitable status

TWO copies of the partnership agreement between the applicant and the sponsoring

agency, if applicable

TWO copies of list of current Board members, of the organization holding charitable

status

TWO copies of the organization’s operating budget for the current year of the

organization holding charitable status

TWO copies of the most recent audited financial statements of the organization holding

charitable status

If you are a Public Agency (i.e. University, Hospital, School Board, Municipality):

Signature of the Head of the Department implementing the project

Date:	______________________________ ______________________________

Executive Director or Head of Department Signature

______________________________

Chairperson of Board of Directors

(Community Organizations only)

APPLICATION FORM–PART 2 OF 2

GRANT APPLICATION - 2016-17

Deadline: July 25, 2016

Applicant information

Organization name: Address: Registered charitable number: Contact person: Position: Telephone: Fax: Website:

Sponsor information (if applicable)

Organization name: Address: Registered charitable number: Contact person: Position: Telephone: Fax: Website: Note: A completed and signed Partnership Agreement must be submitted with the application.

Proposal summary (Please provide a 50 – 100 word summary of your funding request)

Project information

1. Project name: 2. Total project budget: $ over months / years 3. Total Hamilton Community Foundation funding requested: $ If your request is multi-year, please provide the breakdown: Year one $ Year two $ Year three $ 4. Is this project: New Enhancement/expansion of existing project Other (please explain) 5. If you are requesting multi-year funding please provide your rationale: 6. Grants will be considered for two start dates. Which applies to this project?: January 2017 September 2017 7. How many children do you anticipate serving: 8. If this is a school-based program, list the schools where the program will operate. Note where school space/participation has been confirmed: 9. List locations other than schools where the program will be offered:

Section A: Organization/Partnership

Describe how your organization works within the larger education system in Hamilton.

How does your work fit with ABACUS and specifically the four-pillar framework?

List the current programs and services that you provide. Tell us why you are best suited to do the proposed initiative and how you will work with your partners and your community.

Tell us how the proposed initiative relates to your organization’s strategic plan/directions.

Section B: Target population

Clearly describe the target population or target community to be served by this project. Do any barriers exist that might prevent their involvement in the program/initiative? If so, how do you work to eliminate those barriers?

Section C: Community need and project response

What need in your target population does your project aim to address – what barriers does it seek to remove with respect to post-secondary access? What needs assessment data supports your statement of need (local if possible)? What other local services currently address this need?

What is your proposed initiative to meet the need? What are the specific activities that you intend to use to implement your proposed solution? (A workplan is helpful to include). What is the frequency and duration of the program/activity (i.e. 2 hour program available 3 days per week during the school year). Please include timelines.

How do you know that your project will improve the situation for your target population and work toward the goal of increasing the likelihood of post-secondary access?

What other community organizations or partners will be involved in this program and how will they be involved? Do you have formalized partnership agreements/proctocols in place with any of them?

What challenges do you anticipate and how will you address them?

Section D: Evaluation

What specific outcomes related to the goals of ABACUS do you anticipate? How will you know that your project has achieved its outcomes? What specific indicators will you use to measure the achievement of project outcomes?

How will you use the results of the evaluation to continually improve or sustain the program? Describe changes (if any) that have been made to the program based on past evaluations.

Section E: Dissemination

Are you willing to work with HCF and other ABACUS grant recipients to share what has been learned from your project?

Section F: Sustainability

How will the outcomes of your project be sustained into the future? What resources will be required to sustain the outcomes, if any?

Section G: Financial information

Requested budget – Note: this should total your request from HCF

Item	Details	Amount ($)
Total amount	$

Other sources of funding for this project. Please ensure you include the contribution from your own organization if applicable. If a funding source is listed as “anticipated” show a timeframe for when it will be confirmed.

Source Organization Contact name Contact number	Item / Details	Amount	In kind or financial	Anticipated or confirmed
TOTAL	$	$

Section H: Authorized signatures

We hereby make application for a Hamilton Community Foundation ABACUS grant and declare that the information provided in the application form and all required attachments are complete with no misrepresentation. We understand that submitting an application will not necessarily result in funding support from the Hamilton Community Foundation. Furthermore, we understand that applications may be funded in full or in part, and with some conditions. We understand that staff and volunteers of the Hamilton Community Foundation will review our application.

We certify that this application has official approval from the organization’s Board of Directors.

We give Hamilton Community Foundation permission to share the narrative of this application with the Hamilton-Wentworth District School Board and the Hamilton-Wentworth Catholic District School Board.

_____________________ _________________________

Signature of Board Chair Date (M/D/Y) Signature of Executive Director Date (M/D/Y)

Name (print) of Board Chair	Name (print) of Executive Director

Contact Information:

Hamilton Community Foundation, 120 King Street West, Suite 700,

Hamilton, Ontario, L8P 4V2

Phone: (905) 523-5600 Fax: (905) 523-0741

Website: www.hamiltoncommunityfoundation.ca

E-mail: s.charters@hamiltoncommunityfoundation.ca