Disability Funders Network Rapid Response Fund: Funding Application

Tips for Completing the Application Form

• Press the <Tab> key to move from one field to the next.
• Press <Ctrl><Del> to delete the default value in square ([]) brackets and clear the field to permit maximum response space.
• Press <Shift><Tab> to return to the prior field.
• Warning! If you press the <Enter> key before reaching the end of the survey, this may result in your form being submitted with incomplete data. If this happens, simply return to the survey form. If your data is still there, continue entering from that point. If the form has not recorded your responses, please start over.

About Your Organization

1. Full legal name (to which a grant would be payable):
   
2. Street address
3. City State ZIP
4. Web site URL: http://
5. Federal tax I.D. No:
6. Mission statement (no more than two sentences, please):
   
7. Size of annual operating budget of organization:
8. Contact person:
   Name:
   Title:
   Telephone:
   Fax:
   E-mail Address:
9. Name of person authorized to bind organization:
   Title:

About Your Proposed Services or Activities

1. Amount Requested:
2. Mini-description of proposed services (10 words maximum):
   
3. Describe in 250 words or less what you propose to do and how you will do it. Include start and end date of services:
   
4. Description of people to be served … by age, location, disability or cross-disability.
   
5. Do you plan to coordinate with (other) relief organizations in this effort? If so, please describe how and please name those organizations (100 words maximum).
   
6. Tangible outcomes 100 words maximum):
   
7. Do you know of any other public/private funding currently available for this purpose:
   Yes
   No
   If yes, please list:
   
8. Have you applied to other public or private funding sources for these services?
   Yes
   No
   If yes, please list:
   
9. Have you received funding from any other sources for this purpose?
   Yes
   No
   If yes, please list:
   

Financial Information

(1) For example, telephone, postage, lodging, etc. [return to note 1]

Upon completion of the funded activities, a short written report, to include (1) results/impact and (2) financial detail tied to the budget provided in the application must be submitted to Disability Funders Network. Submission of this application for funding represents concurrence with this reporting requirement, which allows DFN to fulfill its obligation to report results to funders of the DFN Rapid Recovery Fund.

• We encourage you to submit this application on-line (see below).
• Communications will be via e-mail whenever possible.
• We understand that not everyone has email capacity at this time — if this is the case, we will accept your application by fax or regular mail. Send to:
  Tracey Murray, Coordinator
  DFN Rapid Response Fund
  8568 Spring Breeze Terrace
  Suwanee, GA 30024
  Phone/Fax: 770-232-9001
  E-mail: disabilityfundersnetwork@cox.net

To submit this form electronically, press the “Submit” button, below.

IMPORTANT: If your submision is successful, you will immediately receive an acknowledgement. If you receive an error or rejection message, you may need to adjust your firewall settings.