HMTA 1

Basic Information

Legal Name of Organization: _*

Tax ID (EIN):*

Website:*

Mailing Address:*

City, State, ZIP:*

Phone*

Applicant Contact Information

Title*

Email*

Phone*

Authorized Representative (Person Signing Grant Agreement)

Please fill out if this is different from the person filling out the application. If it's the same individual, please leave blank or type N/A.

Name:

Title:

Email:

Phone:

Organizational Details

Is your organization a 501(c)(3) public charity in good standing with the IRS? (Must be verifiable via IRS database)*

Year your organization was officially established (minimum 3 years required):*

Briefly describe your organization’s history, mission, and major accomplishments since its founding (200 words max):*

Describe how your organization has demonstrated measurable impact over the past three years. Include specific data, success stories, or key achievements (300 words max):*

How many individuals have been directly served by your programs in EACH of the last three years?*

Please format your response as such: Year 1: _____________ Year 2: : _____________ Year 3: : _____________

What tools or methods does your organization use to measure program effectiveness and impact? (e.g., surveys, case studies, outcome tracking, etc.):*

Does your organization operate from a physical office or a home-based location?*

Are your services provided free of charge?

Is your organization affiliated with another nonprofit or a government entity?*

If yes, please specify.

What is your organization's total annual revenue for the last 2 years?*

Please format as such: Year 1 $_____________ Year 2 $_____________

Provide a breakdown of your organization’s annual expenses for the last 2 years:*

Please include 1. Total Annual Expenses 2. Program Services Expenses 3. Administrative & Overhead Expenses 4. Fundraising Expenses (if applicable) for each of the two years!

How have your organization’s administrative and overhead expenses changed over the last two years? Please explain.*

What percentage of your annual budget is allocated to program services?*

Number of full-time employees*

Number of part-time employees:*

Project Overview & Programmatic Review (Phase 1)

Project Title:*

Briefly summarize the project (250 words max)*

What NFIF Pillars will this project or initiative address? Please list all that apply from the following list: Mental Health, Hunger, Homelessness, Foster Care Transitions & Childhood Illness.

Community Need & Beneficiaries

Describe the problem the project will address (300 words max)*

Who will benefit? (Demographics, number served, geographic area)*

Expected Impact & Evaluation

Measurable outcomes and goals:*

How will success be tracked?*

Can this project be scaled in the future?*

Budget & Financial Transparency

(Attach a project budget breakdown as a PDF or Excel file)

File

Max. file size: 128 MB.

Total Project Cost:*

Amount Requested from NFIF:*

Other secured or pending funding sources:*

Does your organization have unrestricted reserves?*

If yes, please specify:*

Does this project require ongoing funding after the grant period?*

Organizational Capacity & Governance

(Attach a list of the Board of Directors, including years of service)

File

Max. file size: 128 MB.

Who manages your organization’s funds? (Describe accounting systems and financial oversight)*

Does your organization undergo an annual audit or financial review?*

Has your organization received past grants? (Describe fund management and impact)*

Compliance & Accountability

Has your organization ever had a grant revoked or funding suspended?*

If yes, please explain:

Does your organization have financial controls in place for tracking grant funds?*

How will NFIF funding be tracked and reported to ensure compliance?*

Impact Measurement & Reporting

What data will be collected to measure success?*

What reporting tools does your organization use?*

How often does your organization conduct program evaluations? Quarterly, Annually or Other.*

If other was chosen, please specify:

Reapplication & Future Funding

Has your organization previously applied for NFIF grant?*

If yes, indicate year(s) and project funded:

Organizations may apply for funding once per year. Denied applicants and previous grantees must wait one year before submitting a new application. Please write "I acknowledge" to confirm that you have read and agreed to this message.*

Financial Review (Phase 2 – By Invitation Only)

If selected for Phase 2, applicants must submit the following documents within 3 weeks of the request. Failure to meet this deadline will result in automatic disqualification from funding consideration. Required: IRS Form 990 (Last 2 Years). Strongly Recommended: Balance Sheet (Last 2 Years) and Statement of Revenues & Expenses (Last 2 Years).

Final Certification & Agreement

By signing, I certify that: a) The information in this application is true and accurate b) Funds will not be used for lobbying, religious activities, capital improvements, or general operating expenses c) If selected for Phase 2, the organization agrees to submit the required financial documents within three weeks of request The organization agrees to comply with all reporting requirements. Before funds are disbursed, a grant agreement must be signed, acknowledging all reporting and monitoring obligations.

Authorized Representative Name:*

Date*

Submit the application via the NFIF grant portal by the deadline. Incomplete applications will not be reviewed.

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August 5, 2024

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Eligibility Requirements

Funding Restrictions

Application Deadline

Grant Review Process

Phase 1: Programmatic Review

Phase 2: Financial Review (By Invitation Only)

Required Documents: