GRANT APPLICATION FORM

 Thank you for your interest in Ronald McDonald House Charities (RMHC). The enclosed guidelines will provide you with a brief introduction of RMHC and our policies, and a list of the specific information we will need to review your proposal.

SUBMISSION

Use English only and avoid unusual abbreviations. Type directly on this application, single-spaced. If you need more room, use standard white bond (8 1/2 x 11"). Use standard black type that can be photocopied. Draw all graphs, diagrams, tables and charts in black ink. Do not include items that cannot be photocopied.

Your application form should include all items listed under "Specific Instructions." Please do not send videotapes, magazine articles, books or other collateral material at this time. An RMHC representative will contact you if additional information is required.

Once complete, please send two copies of all materials. IF ANY OF THESE DOCUMENTS ARE NOT INCLUDED, YOUR APPLICATION WILL BE CONSIDERED INCOMPLETE AND THE REVIEW WILL BE DELAYED INDEFINITELY OR DECLINED.

SPECIFIC INSTRUCTIONS

The first section should include the following items that are part of the attached application:

A-1: Not-for-profit Organization Submitting Application. Self-explanatory.
B-1:

Title of Project. Choose a title that is descriptive and specifically appropriate rather than general.
C-1:

Program Director/Principal Investigator. Indicate all titles and degrees that are most relevant to the proposed project, such as Professor of English or Director of Pediatric Care.
D-1: Mailing Address and Telephone. Self-explanatory.
E-1

Specific Amount Requested from RMHC. Indicate the dollar amount your organization is requesting from RMHC and a detailed budget totalling to this amount.
F-1:

McDonald's Endorsement. If applicable, a letter of endorsement from the McDonald's representative(s) who is/are familiar with your organization. Include all titles, addresses and telephone numbers. We will contact this individual for information.
G-1:

Target Audience and Performance Sites. Summarizes your population in measurable terms, i.e., who the primary audience is, how many will be served, how old the participants are, where the program will be offered, and the geographic range of your organization. Indicate where the program will take place, including states, hospitals, schools, etc.
H-1:

Background and Significance. Briefly include a background of the not-for-profit organization that is submitting the application.
I-1:

Objection and Aims. State the broad, long-term objectives and describe concisely and realistically what the research or program described in this application is intended to accomplish.
J-1: Description of Project. Provide a concise description of the need or problem to be addressed. Include the overall goals and purposes of your organization or specific department concerned, the specific purpose of the funds, and how your objectives will be accomplished. Moreover, what is unique about your program?
K-1: Evaluation of Program. Indicate how your organization will evaluate the program if funded, such as questionnaires, surveys, etc.

 

The second section should include the following items bound together in the order in which they are listed:

 
A-2: Checklist. The enclosed checklist to indicate that you have submitted all required information.
B-2: Cover Letter. A one- or two-page cover letter on your stationery, signed by the senior management official, briefly outlining your proposal with the request.
C-2: IRS 501(c)(3) Form. A copy of the Internal Revenue Service ruling of the organization's tax exempt status under Section 501(c)(3). Letters must be clearly dated, indicating the name of the organization, and specifying that it has been granted charitable tax exempt status. Please note that if applicants are using other agencies' 501(c)(3) status, please clearly indicate which 501(c)(3) status letter applies to the organization, and why the application is being submitted under different status.
D-2: Budget and Financial Statements. A detailed budget that specifically outlines all funds that you are requesting from RMHC. This includes all direct and total costs for the first year of the program (if applicable) and direct and total costs of the entire proposed project period. In addition, please indicate how this program will be funded in the following year(s). Include the current year's operating budget, which should list basic categories of revenues and expenses, and complete audited financial statements including balance sheet for the organization.
E-2: Past Donor Information. A donor's list, showing all private, corporate and foundation support during the past 12 months, Also, include a list of the organization's board of directors.

ACKNOWLEDGEMENT OF RECEIPT

RMHC acknowledges proposals within 30 days of receipt by letter. However, proper investigation and assessment of your application may take up to 60 days. When the investigation is complete, another letter will be sent confirming when your application will be reviewed by the Board of Trustees.

AWARDING OF GRANTS

All Board decisions on requests are reported by mail. The applicants whose proposals have been approved will receive a Letter of Agreement outlining the terms and conditions of the grant. An authorized organization official must sign and return the letter to RMHC, thereby indicating acceptance of the terms and conditions of the award. This letter will also highlight arrangements for payment of the grant.

RESPONSIBILITY OF RECIPIENT

The recipient of any grant from RMHC must use the funds awarded for the specific purpose for what they were originally intended. RMHC requires that a detailed accounting of all funds along with a follow-up report be submitted no more than a year from the date of the award. Any funds not used in the above manner specified will be returned to RMHC.

FOR FURTHER INFORMATION

Please address all correspondence to:

Ronald McDonald House Charities of Western Wisconsin and Southeastern Minnesota
Courtesy Corporation
2700 National Drive, Suite 100
Onalaska, WI 54650

If you have any questions about your application, please call 608/781-8080.

Again, thank you for your interest in RMHC. We look forward to hearing from you.

 

Date Rec'd ____________

Grant No. ________________

 

A-1: NAME OF ORGANIZATION _______________________________________
B-1: PROJECT TITLE _______________________________________
C-1:

PROGRAM DIRECTOR/
PRINCIPAL INVESTIGATOR

 _______________________________________

D-1:

MAILING ADDRESS

 _______________________________________
    _______________________________________
    _______________________________________
 

CITY

_______________________________________
  TELEPHONE _______________________________________
E-1:

SPECIFIC AMOUNT
REQUESTED FROM RMHC $

_______________________________________
 

 

Please include all budget information in the second section of this application (See item D2 under "Specific Instructions.") If it is not included, your application will not be reviewed

 
F-1:

McDONALD'S ENDORSEMENT

Please name the nearest McDonald's representative in your area. Your request will receive the same consideration whether or not you have had contact with McDonald's.
  McDONALD'S CONTACT _______________________________________
  TITLE/POSITION _______________________________________
  ADDRESS _______________________________________
    _______________________________________
    _______________________________________
  CITY _______________________________________
  TELEPHONE _______________________________________
 

 

To what extent have you worked with the McDonald's representative?

 

 

  
G-1:

TARGET POPULATION AND PERFORMANCE SITES
Please summarize your target population in measurable terms, i.e., who the primary audience is, how many will be served, how old are the participants, and where the program will be offered, and the geographic range of your organization. For example: 125 physically impaired children ages 6-12 throughout Arizona, or 1,000 Hispanic high school seniors in New York City.

 

 
H-1:

BACKGROUND AND SIGNIFICANCE
Briefly include a background of your organization.

 

 
I-1:

OBJECTIVES AND AIMS
State the broad, long-term objectives and describe concisely and realistically what the program or research described in this application is intended to accomplish.

 
J-1:

DESCRIPTION OF PROJECT
Please provide a concise description of the need or problem to be addressed. Include the overall goals and purposes of your organization or specific department concerned, the specific purpose of the funds, and how your objectives will be accomplished. Moreover, what is unique about your program?

 
D-1:

EVALUATION
Indicate how your organization will evaluate the program if funded, such as questionnaires, surveys, etc.

 

RONALD McDONALD HOUSE CHARITIES
CHECKLIST

(Include this checklist with your application.)

______ COVER LETTER

______ McDONALD'S ENDORSEMENT

______ IRS 501(c)(3) FORM

______ BUDGET AND FINANCIAL STATEMENTS (including balance sheet)

______ TITLE OF NOT-FOR-PROFIT ORGANIZATION

______ TITLE OF PROJECT

______ PROGRAM DIRECTOR/PRINCIPAL INVESTIGATOR

______ MAILING ADDRESS AND TELEPHONE

______ BACKGROUND AND SIGNIFICANCE

______ OBJECTIVES AND AIMS

______ TARGET AUDIENCE AND PERFORMANCE SITES

______ EVALUATION

______ PAST DONOR INFORMATION

 

 

RONALD McDONALD HOUSE CHARITIES
Follow-up Report

(Required within one year of date award granted.)

If your proposal is approved, you will be required to address the following questions 30 days after your program's completion. This allows Ronald McDonald House Charities to ensure RMHC grants are used to their full potential.

1.

Has the need been met or the problem solved? Please include updated information about the project (number of people served, new programs or opportunities, etc.)

2.

Did the project follow the objectives? If not, why?

3.

Has the project been modified since the proposal was presented to RMHC?
4.

Have there been major changes in timetables for project development, implementation, and completion? What were the reasons for such changes?
5.

Has the personnel involved in the project proven to be adequate in numbers and qualifications? Has additional staff or staff with different qualifications been required?
6.

Have any plans for cooperation with other institutions or groups been implemented successfully? If not, what have been the reasons?
7. What have been your methods of evaluating this project?
8.

What was the impact of the project on your organization and on those people it was designed to serve? Has the project led to the development of similar ones in other organizations?
9. Include complete financial reporting of the grant.
10. Did it really make a difference?