Save and Continue Test A test of the save and continue feature Name of Organization(Required)Contact Completing ApplicationName(Required) First Middle Last TitleEmail(Required) Phone(Required)Executive Director or Chief OfficerName(Required) First Middle Last Title(Required)Email(Required) Organization InformationPrimary Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Do you have a different mailing address?(Required)Select One…YesNoMailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone(Required)Website UrlFacebook Page UrlIs your organization a non-profit (501c3)?(Required)Select One…YesNoPlease Enter Your EIN Number(Required)Does your organization have a Fiscal Agent?(Required)Select One…YesNoFiscal Agent Organization Name(Required)Fiscal Agent EIN(Required)List the names of Board Officers (with title) and all Board Members of your organization or Fiscal Agent.(Required)Full NameTitle Add RemoveNote: If you have a Fiscal Agent, list the names of the local Board or individuals responsible for the project.Geographical Area Served: Check One(Required) East Contra Costa Central Contra Costa East and Central Contra Costa List Cities/Areas Served(Required)Briefly, state the mission/purpose of your organization and include a description of the populations you serve(Required)Annual organizational budget(Required)Number of clients served per yearName of Project to be funded(Required)Enter the amount you are requesting for this project (max $20,000)(Required)Please enter a number from 1 to 20000.Please break down your project budget costs as follows:ExpensesPersonnel Amount (Ex. $1000, etc)Operations Amount (Ex. $1000, etc)Subcontractors Amount (Ex. $1000, etc)Other Amount (Ex. $1000, etc)Total Project Budget(Required)Partner organizations you are working with to implement and fund this project (if applicable)Partner OrganizationRolePartner Funding (if any) Add RemoveUse the plus sign to add more partnersProvide a brief description of how these funds will support your effort in roughly 500 words or less. Include your overall purpose/goals; how this grant will support justice-system involved youth and/or youth at risk of system involvement, promote strategies and best practices that effectively prevent or reduce juvenile crime, and provide youth and their families with opportunities to achieve, grow, and thrive.(Required)In 500 words or less, describe your approach for reaching your desired outcomes, and the specific programs/services you will provide in any of the following areas: (1) Academic success and tutoring , (2) Mentorship, (3) Leadership development, civic engagement/social justice, (4) Prevention-focused programming (including mental health and socio-emotional health programs and services), (5) Youth employment (including internships or work-ready skills training, etc.)(Required)You may attach a copy of your project’s logic model or a statement/graphic of your project’s theory of change to this application (optional) Drop files here or Select files Max. file size: 5 MB, Max. files: 2. Please include a description of the target population(s) to be served; where (please specify cities) and when activities will take place; the projected numbers of participants that will be served by this project; and the benefits to the community and to participants served.(Required)Please provide a detailed project timeline including information on the program, event, or activity(s) start date(s) and duration(Required)In 350 words or less, describe the metrics/measures you will use to evaluate, track, and report the impact/results of your project.(Required)Enter demographics on the target populations of this project. Provide your best estimates of the number of people served by age, gender, and/or race.(Required)Provide your best estimates of the number of people served by city.(Required)City Served By ProjectPeople Served (Ex. 100, 1000, etc) Add RemoveDescribe how you will acknowledge the Youth of Promise Fund and the support of the Antioch Community Foundation. (e.g., in program material, social media, press, event announcements, etc.)(Required)Is your organization able to provide ACF with high quality photos from ACF supported events(Required)Select One…YesNoYour organization will have an opportunity to approve any content used by ACF and contributing content is not a requirement to receive a grant.
