Verizon Foundation

Sample Grant Applications

Competitive Grant - Internet Safety

Please note that this sample application is for reference use ONLY. You must log in to actually submit a proposal.

Preview Form
This is an example of the application questions with which you will be presented. It is recommended that you compose the answers to the paragraph questions in a word processing program and then cut and paste that text into the online application.
Contact Information
Please provide the following information so that we may contact you regarding your proposal.
1) Salutation Preferred salutation (Ms., Mr., Mrs., Dr., etc.)
2) Last Name (required)
3) First Name (required)
4) Middle Name
5) Title (required)
6) Contact Type (required)
7) Address (required)
8) City (required)
9) State (required)
10) Province
11) ZIP Code (required)
12) Telephone (required)
13) Fax
14) E-mail Address (required)

Organization Certifications

All applicants must answer the following questions regarding their organization in order to be considered for a Verizon Foundation grant. PLEASE NOTE: Answering no to any of the following questions does not imply ineligibility.

1) No Verizon employee, customer, or board members has a financial interest (required)

2) No branch offices, operations, or representation in U.S. sanctioned countries. (required)

3) Board, staff and organization are free of indictments, convictions, and conflicts of interest (required)

4) Organization has one separate financial or accounting person or function. (required)

5) Organization has conflict of interest policy and procedures (required)

6) The organization has at least 3 board members (required)

7) If answering "no" to any of the above questions, please explain. (required)
NOTE: Answering "no" to any question does not imply ineligibility. If answering "yes" please populate this field with N/A.

1500 character maximum

8) Organization Accuracy Certification (required)
I certify that all preceding organization information (including the Legal Name, Address, and certifications) is accurate and complete as of today's date. I acknowledge that any information that is found to be inaccurate or incomplete could possibly delay or disqualify any funding that this organization might receive.

Yes

509(A)(3) Tax Status Information

9) 509(a)(3) Supporting Organization Type

If you are a 509(a)(3) tax status, please select your Supporting Organization Type.

10) 509(a)(3) Type III Integrated with Support Organization

If you are a 509(a)(3) Type III Supporting Organization, are you functionally integrated with the organization you support?

Organization Information
Please provide the following information about your organization. Additional guidance and examples for applicants can be found online.
1) Legal Name (required)
2) AKA Name Your organization may also be known as...
3) In Care Of Name Legal name of the organization corresponding to the specified tax ID. This is used only if your organization lacks its own tax ID or is applying for funding using another organization's tax ID. Actual funding will be provided to the In Care Of organization.
4) Relationship to 'in care of' organization
5) Address (required)
6) City (required)
7) State (required)
8) ZIP Code (required)
9) Province
10) Country (required)
11) Telephone (required)
12) Fax
13) Web Site Address
14) E-mail Address
What is your mission, your vision, and any key points of approach? We see mission as what you do and vision as the end state you wish to achieve. The best mission and vision statements are short and clear. We are especially interested in how your mission gives you concentration and focus-discouraging you from simply taking on more projects because money is available. Finally, if you have values, principles, strategies that guide where you go or how you work, please include them and be specific about how they shape your actions.
15) Organization Mission (required) 500 character maximum
16) Organization Vision (required) 500 character maximum
17) Organization Key Points (Values, Principles and Strategies) (required) 500 character maximum
18) Please summarize your strongest achievements in the past three years - meaning those who benefited. (required) Please speak to accomplishments from participants, not programs themselves. Also please specify how many people have tangibly improved their life than on how much money you have attracted or what awards you may have received-unless the recognition is clearly based on participant outcomes. 500 character maximum
What demographics do you serve and what ethnic reach does your organization have overall? We are trying to get a sense of the magnitude of the problem within your demographic/ethnic focus. When it comes to the number, just rely on existing data - whether it comes from the Internet or from estimates by those in your area in the best position to know.
19) Community Ethnicity (required) Please provide an ethnicity distribution for the community that your organization generally works to support. While this information will not have any weight in the decision of your proposal, it is still required for our internal tracking purposes. % American Indian or Alaska Native % Asian or Pacific Islander % Black or African American % Hispanic or Latino % White or Caucasian
20) What other demographic groups do you serve? (required) Does your organization work with a particular age group, gender, or other segment of the population? 500 character maximum
In your geographic area, whether local, state or national, what are the three organizations that are most similar to you? And what differentiates you from them? Few groups are so unique that they have no comparable organizations. We want to know who you see as most similar so that we can look at a broader picture of organizations approaching the same issues within an area and gain a sense of how you are different. This question encourages you to tell us what we should remember about you, what makes you stand out in some way.
21) Three similar organizations (required) 500 character maximum
22) What makes you different? (required) 750 character maximum

Organization Information
Please provide the following information about your organization. Additional guidance and examples for applicants can be found online.
1) Legal Name (required)
2) AKA Name Your organization may also be known as...
3) In Care Of Name Legal name of the organization corresponding to the specified tax ID. This is used only if your organization lacks its own tax ID or is applying for funding using another organization's tax ID. Actual funding will be provided to the In Care Of organization.
4) Relationship to 'in care of' organization
5) Address (required)
6) City (required)
7) State (required)
8) ZIP Code (required)
9) Province
10) Country (required)
11) Telephone (required)
12) Fax
13) Web Site Address
14) E-mail Address
What is your mission, your vision, and any key points of approach? We see mission as what you do and vision as the end state you wish to achieve. The best mission and vision statements are short and clear. We are especially interested in how your mission gives you concentration and focus-discouraging you from simply taking on more projects because money is available. Finally, if you have values, principles, strategies that guide where you go or how you work, please include them and be specific about how they shape your actions.
15) Organization Mission (required) 500 character maximum
16) Organization Vision (required) 500 character maximum
17) Organization Key Points (Values, Principles and Strategies) (required) 500 character maximum
18) Please summarize your strongest achievements in the past three years - meaning those who benefited. (required) Please speak to accomplishments from participants, not programs themselves. Also please specify how many people have tangibly improved their life than on how much money you have attracted or what awards you may have received-unless the recognition is clearly based on participant outcomes. 500 character maximum
What demographics do you serve and what ethnic reach does your organization have overall? We are trying to get a sense of the magnitude of the problem within your demographic/ethnic focus. When it comes to the number, just rely on existing data - whether it comes from the Internet or from estimates by those in your area in the best position to know.
19) Community Ethnicity (required) Please provide an ethnicity distribution for the community that your organization generally works to support. While this information will not have any weight in the decision of your proposal, it is still required for our internal tracking purposes. % American Indian or Alaska Native % Asian or Pacific Islander % Black or African American % Hispanic or Latino % White or Caucasian % Other/Unspecified
20) What other demographic groups do you serve? (required) Does your organization work with a particular age group, gender, or other segment of the population? 500 character maximum
In your geographic area, whether local, state or national, what are the three organizations that are most similar to you? And what differentiates you from them? Few groups are so unique that they have no comparable organizations. We want to know who you see as most similar so that we can look at a broader picture of organizations approaching the same issues within an area and gain a sense of how you are different. This question encourages you to tell us what we should remember about you, what makes you stand out in some way.
21) Three similar organizations (required) 500 character maximum
22) What makes you different? (required) 750 character maximum

Proposal Information

1) Project Title (required) Please enter a descriptive title for your project or program.
2) Request Date (required)	(MM/DD/YY)
3) Request Amount (required)
4) Funding Areas (required) Please select from one of the following funding principles as they pertain to your project.
5) Project Start Date	(MM/DD/YY)
6) Project End Date	(MM/DD/YY)
Proposal Narrative Please provide us with a summary of your program or project in the spaces below. Please be very focused in your responses so that we may gain an understanding of your program/project. In "What you will do", for example, summarize what your program/project does to achieve results for those it serves.
7) Please specifically state/explain how Verizon Foundation's funding will be used in the proposed program/project. (required) approx. 10 page maximum
8) Specifically state the social cause/issue you intend to address. (required) 2000 character maximum
9) Specifically state what you will do to address this cause. (required) 1000 character maximum
10) Please state how technology will be used to achieve your results. (required) 2000 character maximum

Your Participants
Additional guidance and examples for applicants can be found online.
What geographic area do you serve and about how many people are affected by the social cause within that area? We are trying to get a sense of the magnitude of the problem within your geographic focus. When it comes to the number, just rely on existing data - whether it comes from the internet or from estimates by those in your area in the best position to know.
1) Geographic Area (required)
2) Number affected by the social cause (required)
Who are your program participants and how many will you serve? What are the key characteristics of these participants and are they in any way different from the full set of people who have the problem? In characteristics, we are interested not just in such factors as gender and race, but also defining who you serve by the degree of the challenge to get to the result you intend. We know, for example, that it is much harder to get children to the right literacy level if they are two, rather than one, grades behind in reading and if their primary language is not English. Please know that we view it as a sign of strength that a program/project has defined the people who are most likely to benefit from a particular approach. It is rare that one program is the best fit for everyone.
3) Specifically state for whom you will address this cause. (required) 1000 character maximum
4) Estimated Gender Served (required) Please provide a breakdown by percentage of the genders that this proposal will work to support.	% All % Females % Males
5) Estimated Age Group Served (required) Please provide a breakdown by percentage of the Age Groups that this proposal will work to support.	% Adults % All % College % Elderly % K - 12 % Preschool
6) Estimated Ethnicity Served (required) Please provide a breakdown by percentage of the ethnicities that this proposal will work to support.	% American Indian or Alaska Native % Asian or Pacific Islander % Black or African American % Hispanic or Latino % White or Caucasian
7) Estimated Population Served (required) Please provide a breakdown by percentage of the Population that this proposal will work to support.	% Disaster Victims % Family % Gay / Lesbian / Transgender % General Public % People with Disabilities % Teachers % Underprivileged
8) Number served by your organization (required)

Your Approach
Additional guidance and examples for applicants can be found online.
1) What overall approach or strategy are you using to achieve results? (required) Please note any evidence that exists, that illustrates this strategy's ability to achieve your results. If this program/project is not evidence -based, explain the process by which this strategy was developed. Most programs/projects are not a random set of activities. They are a coherent approach to achieve a result. Please tell us about the core elements of your particular way of solving a problem and why you think it is the best way to engage participants and help them get to the success you have stated. If the approach is evidence-based (in the sense that information exists to show its power to achieve results), tell us what it is. A quick summary and reference to a web site with relevant research is fine to include. 1000 character maximum
What level of intensity (i.e. frequency of service) and duration (i.e. period in which you provide service for a person) are needed for your approach to deliver results? Once you give the number add your thought on rationale. Some projects fall short of results not because they are a poor approach but because they are not implemented with enough intensity or duration to make a difference. Programs that mentor students, for example, may need several sessions per week to make a difference. A lighter touch (e.g., once every other week) would let a group mentor more students for the same budget, but what's the point if this is not intense enough to achieve an academic outcome? We fully understand that you may need to reduce the number served to increase the number who gain.
2) Intensity - Number of Hours Per Week (required)
3) Intensity - Explanation (required) 750 character maximum
4) Duration - Number of Weeks (required)
5) Duration - Explanation (required) 750 character maximum

Intended Outcomes
Please complete the same sections that you completed in the Proposal Intent portion of this application (Law Enforcement Officers, Youth/Adults, Parents/Caregivers). In the sections that are not applicable to your proposal, please use N/A or 0 as answers. Please note that we define a result not as people reading materials or sitting through a workshop but as something they gain from the activity. Please insure that the result is either a direct gain in one of our focus areas (e.g., a given number youth or adults that implement at least one new internet safety approach) or a change in condition or behavior that is a good predictor of that success longer term. At a workshop, you might not be able to state specific changes made by participants after they leave, but you can focus on demonstrated learnings or commitments that in turn predict those gains longer term.
Section 1: Intended Outcomes for Law Enforcement Officers
1) If your program focus is targeting Law Enforcement Officers, how many do you plan on serving with this funding? (required) Enter the total number or use "0" if you are not serving Law Enforcement Officers.
2) What program results are you committed to achieving for Law Enforcement Officers? (required) Click here for specific instructions on creating your result statement Enter your results statement here or use "N/A" if you are not serving Law Enforcement Officers. 750 character maximum
3) Number of Law Enforcement Officers reaching the desired program results (required) This number is a subset of the overall number of Law Enforcement Officers you plan to serve in your program from question 1 above. For example, if your program/project serves 100 participants overall and you anticipate that 50% of those served will achieve the program result you stated, the number of people reaching the desired program/project result would be 50. Enter the total number or use "0" if you are not serving Law Enforcement Officers.
4) How will you know when your expected results for Law Enforcement Officers have been achieved? What information or evidence will you use to verify success? (required) We simply want to know what information or evidence you will use to verify that your stated result in question 2 above has been achieved. You may well be able to use existing data bases or rely on existing measuring instruments. Or you may be able to use observations and reports by others, or in some cases self-reported behaviors. Enter your verification here or use "N/A" if you are not serving Law Enforcement Officers. 2000 character maximum
About how many of the Law Enforcement Officers in your result might reasonably achieve this gain if your program/project were not undertaken? We believe that our return on grant investment is not the result you achieve. It is the difference between your result and what would have happened without you. It is rarely the case that no one you serve would have achieved a result given other progress and forces at work. We are not asking you to do original research. Just rely on whatever information exists about outcomes at the most specific level you can get it. Past rates of literacy or academic achievement in a school or neighborhood beat a district or a city. And a city beats a state or the nation. If no information exists, use the most educated guesses you can find - for example from teachers or guidance counselors if your focus is schools.
5) Number of Law Enforcement Officers reaching the primary desired result without this program/project? (required) Please enter the number of Law Enforcement Officers that would reach the desired result without this program/project. Enter the total number or use "0" if you are not serving Law Enforcement Officers
6) Are there broader gains or benefits that will be realized if you achieve your results, and that we should be aware of when considering your program/project for Law Enforcement Officers? (required) You may have benefits to add such as: The "life cycle" cost savings from solving a problem. The value of model-building or testing with implications for many programs. A test of ways to reduce costs, again with long term financial implications. Please be specific. We are less interested in broad contributions to values than in specific benefits for people and the organizations that support them. Enter the broader gains or benefits here or use "N/A" if you are not serving Law Enforcement Officers. 1000 character maximum
7) Half way through your program/project, how will you know if Law Enforcement Officers are on course to get to stated results with the time and funding remaining? (required) The easy answer to this question is that yes we are on course - we have spent half the money and are half way through our work plan. This, however, says nothing about the relationship between money spent and participant progress. The key is to shift the focus from what you are offering to what your participants are getting. The best answers to this question speak to what you need to see in terms of participant progress at the half way mark that predicts that they will successfully achieve the result at the end of the program/project. Whenever possible look at predictive factors in terms of behaviors rather than attitudes. They are much easier to see and often are the critical points of progress. In some cases, you may also need to have a specified number of persons at the point of full result to predict overall success. Enter how you will know Law Enforcement Officers are on course here or use "N/A" if you are not serving Law Enforcement Officers. 1000 character maximum
Section 2: Intended Outcomes for Youth / Adults
1) If you selected Youth/Adults in the proposal intent of this application, how many do you plan on serving with this funding? (required) Enter the total number or use "0" if you are not serving Youth/Adults.
2) What program results are you committed to achieving for Youth/Adults? (required) Click here for specific instructions on creating your result statement Enter your results statement here or use "N/A" if you are not serving Youth/Adults. 2000 character maximum
3) Number of Youth/Adults reaching the desired program results? (required) This number is a subset of the overall number of Youth/Adults you plan to serve in your program from question 1 above. For example, if your program/project serves 100 participants overall and you anticipate that 50% of those served will achieve the program result you stated, the number of people reaching the desired program/project result would be 50. Enter the total number or use "0" if you are not serving Youth/Adults
4) How will you know when your expected results for Youth/Adults have been achieved? What information or evidence will you use to verify success? (required) We urge you go back and forth between this question and the question on your project results such that you state a result that can be verified. One good approach where possible is to build in the measuring stick in the target. For example, of the 80 adults we will serve in this literacy program at least 40 will improve by one full level on the widely respected ABC Scale. The verification is then simple: a comparison of achievement at the beginning and end of the program to see if that one unit gain was realized. Please note that we are not asking for a formal evaluation. We simply want to know what information or evidence you will use to verify that your stated result has been achieved. Enter your verification here or use "N/A" if you are not serving Youth/Adults. 2000 character maximum
About how many of the Youth/Adults in your result might reasonably achieve this gain if your program/project were not undertaken? We believe that our return on grant investment is not the result you achieve. It is the difference between your result and what would have happened without you. It is rarely the case that no one you serve would have achieved a result given other progress and forces at work. We are not asking you to do original research. Just rely on whatever information exists about outcomes at the most specific level you can get it. Past rates of literacy or academic achievement in a school or neighborhood beat a district or a city. And a city beats a state or the nation. If no information exists, use the most educated guesses you can find - for example from teachers or guidance counselors if your focus is schools.
5) Number of Youth/Adults reaching the primary desired result without this program/project? (required) Please enter the number of Youth/Adults that would reach the desired result without this program/project. Enter the total number or use "0" if you are not serving Youth/Adults.
6) Are there broader gains or benefits that will be realized if you achieve your results, and that we should be aware of when considering your program/project for Youth/Adults? (required) You may have benefits to add such as: Secondary gains that will come from the primary result you are intending (the documented gains in preventing high school drop out from early grade literacy is an example.) The value of building or testing a model that could be replicated by many other organizations. Enter the broader gains or benefits here or use "N/A" if you are not serving Youth/Adults. 1000 character maximum
7) Half way through your program/project, how will you know if Youth/Adults are on course to get to stated results with the time and funding remaining? (required) The easy answer to this question is that yes we are on course - we have spent half the money and are half way through our work plan. This, however, says nothing about the relationship between money spent and participant progress. The key is to shift the focus from what you are offering to what your participants are getting. The best answers to this question speak to what you need to see in terms of participant progress at the half way mark that predicts that they will successfully achieve the result at the end of the program/project. Whenever possible look at predictive factors in terms of behaviors rather than attitudes. They are much easier to see and often are the critical points of progress. In some cases, you may also need to have a specified number of persons at the point of full result to predict overall success. Enter how you will know Youth/Adults are on course here or use "N/A" if you are not serving Youth/Adults. 1000 character maximum
Section 3: Intended Outcomes for Parents / Caregivers
1) If you selected Parents/Caregivers in the proposal intent of this application, how many do you plan on serving with this funding? (required) Enter the total number or use "0" if you are not serving Parents/Caregivers.
2) What program results are you committed to achieving for Parents/Caregivers? (required) Click here for specific instructions on creating your result statement Enter your results statement here or use "N/A" if you are not serving Parents/Caregivers. 750 character maximum
3) Number of Parents/Caregivers reaching the desired program results? (required) This number is a subset of the overall number of Parents/Caregivers you plan to serve in your program from question 1 above. For example, if your program/project serves 100 participants overall and you anticipate that 50% of those served will achieve the program result you stated, the number of people reaching the desired program/project result would be 50. Enter the total number or use "0" if you are not serving Parents/Caregivers.
4) How will you know when your expected results for Parents/Caregivers have been achieved? What information or evidence will you use to verify success? (required) We urge you go back and forth between this question and the question on your project results such that you state a result that can be verified. One good approach where possible is to build in the measuring stick in the target. For example, of the 80 adults we will serve in this literacy program at least 40 will improve by one full level on the widely respected ABC Scale. The verification is then simple: a comparison of achievement at the beginning and end of the program to see if that one unit gain was realized. Please note that we are not asking for a formal evaluation. We simply want to know what information or evidence you will use to verify that your stated result has been achieved. Enter your verification here or use "N/A" if you are not serving Parents/Caregivers. 2000 character maximum
About how many of the Parents/Caregivers in your result might reasonably achieve this gain if your program/project were not undertaken? We believe that our return on grant investment is not the result you achieve. It is the difference between your result and what would have happened without you. It is rarely the case that no one you serve would have achieved a result given other progress and forces at work. We are not asking you to do original research. Just rely on whatever information exists about outcomes at the most specific level you can get it. Past rates of literacy or academic achievement in a school or neighborhood beat a district or a city. And a city beats a state or the nation. If no information exists, use the most educated guesses you can find - for example from teachers or guidance counselors if your focus is schools.
5) Number of Parents/Caregivers reaching the primary desired result without this program/project? (required) Please enter the number of Parents/Caregivers that would reach the desired result without this program/project. Enter the total number or use "0" if you are not serving Parents/Caregivers.
6) Are there broader gains or benefits that will be realized if you achieve your results, and that we should be aware of when considering your program/project for Parents/Caregivers? (required) You may have benefits to add such as: Secondary gains that will come from the primary result you are intending (the documented gains in preventing high school drop out from early grade literacy is an example.) The value of building or testing a model that could be replicated by many other organizations. Enter the broader gains or benefits here or use "N/A" if you are not serving Parents/Caregivers. 2000 character maximum
7) Half way through your program/project, how will you know if Parents/Caregivers are on course to get to stated results with the time and funding remaining? (required) The easy answer to this question is that yes we are on course - we have spent half the money and are half way through our work plan. This, however, says nothing about the relationship between money spent and participant progress. The key is to shift the focus from what you are offering to what your participants are getting. The best answers to this question speak to what you need to see in terms of participant progress at the half way mark that predicts that they will successfully achieve the result at the end of the program/project. Whenever possible look at predictive factors in terms of behaviors rather than attitudes. They are much easier to see and often are the critical points of progress. In some cases, you may also need to have a specified number of persons at the point of full result to predict overall success. Enter how you will know Parents/Caregivers are on course here or use "N/A" if you are not serving Parents/Caregivers. 1000 character maximum

Key People

Who are the persons you see as critical to program/project achievement and what attributes of these people most predict success? Individuals are often as critical as great plans, a big committee, or even a lot of money in achieving results. While you may first consider resume details - e.g., degrees and years of experience-do recognize that in many areas, there is no strong correlation between these factors and ability to run an effective program/project. We urge you to include at least some persons who directly interact with your participants. They may be as critical as an Executive Director!
1) List the people who will be responsible for the program/project (required) 500 character maximum
2) What attributes of these people most predict success? (required) 1000 character maximum
Partners & Intermediaries Some programs/projects fail because they did not fully understand groups and individuals on whom they were dependent for success. Without getting overly complex, we suggest it useful to think about two kinds of persons who may be critical: Partners are those groups with whom you collaborate to deliver a program. They may be a direct part of your delivery or critical on a contingent basis. A program, for example, may need a clinical specialist to be available at critical points where a person needs specialized help-whether in cognitive processing, a health or mental health issue, or anything else blocking success. Intermediaries are groups who must do something to allow your program to rollout. While not part of your delivery, they are often critical, as gatekeepers or resource providers. An in-school prevention program, for example, can't get to kids if the teacher, principal or other decision maker does not participate/contribute to the program/project.
3) Are there any partners who must play a key role for you to achieve success? (required) If so, please list them here along with the roles they must play, and the evidence that they are committed to play that role. 1000 character maximum
4) Are there any intermediaries who must play a key role for you to achieve success? (required) If so, please list them here along with the roles they must play, and the evidence that they are committed to play that role. 1000 character maximum
5) Could you possibly use Verizon employees or retirees as volunteers in this or other programs/projects? (required) We'd like to alert Verizon employees and retirees who live or work in your area to your need for more help to go with any financial investment we might make. Please think creatively about how you might use additional hands-many of them are very skilled in a variety of ways as mothers and fathers and civic contributors-not just as productive members of our company.
6) If so, how might volunteers help you? (required) Be specific about the roles they might play. If answering "No" please populate this field with N/A. 1000 character maximum

Communications
1) Both during and after the project/program, which are the groups/audiences you most want to reach. What kinds of messages do you want to give them? How will you deliver these resources? What do you want them to do with these messages? (required) Virtually all programs are enhanced by effective communications. During a program it can be critical to getting more persons to participate, and sustaining interest by participants and key stakeholders. After the program, it can be critical to deeper and wider impact. We ask you to think about this area in the terms of who you most want to reach and with what messages. We also think you (and we) would like to know how you will communicate the messages to these groups (e.g., electronic or print media, in person, etc), and with what desired responses. In many instances, communications is designed not just to inform but to persuade. You want someone to do something with the information they receive. 2000 character maximum
2) What approaches will you use to communicate Verizon's role as your partner in this work? (required) Please define the different ways in which our support will be known and to what groups. We join with you in wanting to communicate both your successes and learning, and our partnership for this area of critical work. For us it is a branding of our foundation - and the corporation that makes it possible - as a positive gain for the communities we serve. 2000 character maximum
3) Number estimated to see Verizon as your partner. (required)

Financials

What is the total budget for the program/project? We look at money in two terms. We focus on 1) how reasonable costs appear to be and 2) whether expenditures are in line with your approach.
1) Project Budget Breakdown The overall budget process helps to strategize, manage and monitor your organization's course of action. A comprehensive budget acts as a long-range financial plan and operations guide. It is another effective way of communicating your organization's mission, goals, programs, activities of your staff, and the communities you serve. This form is intended to help you communicate both the resources and expenses for this project. Grant requests of $10,000 or more are required to include a breakdown of the program/project (i.e., dollars requested from Verizon Foundation) by either uploading a budget template or answering the Organization Income, Verizon-Funded Budget, and Overall Project Budget questions below. Please click here to download the foundation's budget template to your computer. When you have finished working on the breakdown, save the document, close out of MS Word, and then click on the Upload link to finish attaching the completed document to your application. Please note that no more than 15% of the total grant request may be used for general operating and administrative expenses. However, if the operarting expense type is considered a direct program expense (e.g., counselor's salary for a domestic violence prevention program), the 15% limit is waived in its entirety. Upload File (Click for instructions)
2) Organization Income Catalogue & Gift Shop Fees Community Charities Foundations/Corporations Funding Fundraisers Government Funding Individual Contributions Sponsorships $0.00 Total
What is the total, overall cost of the program/project proposed and what are you doing to find other necessary funding? We focus on the cost relative to the gain as we consider the quality of proposed projects. Therefore, we need to know the total program/project cost-whether covered by us or other investors. We also want to know if the project is contingent on future funding decisions by other groups.
3) Cost of Project (required) Verizon Foundation Support Non-Verizon Foundation Support $0.00 Total
4) Verizon-Funded Budget Consulting Marketing/Advertising/Public Relations Other Costs Specific to Project Printing/Publication Costs Project Management (staff) Research and Evaluation Scholarships Supplies/Support Materials Technology (hardware & software) Technology Application/Development/Hosting Training/Professional Development Travel & Lodging $0.00 Total
5) Other Costs Specific to Project If you included totals in the "Other Costs Specific to Project" line item(s) above please briefly describe them here.
Additional Funders Details Please list your top three sources of revenue and note the average annual amount you receive from each of the following categories.
6) Funders - Individual (required) 500 character maximum
7) Funders - Corporate Foundations (required) 500 character maximum
8) Funders - Private Foundations (required) 500 character maximum
9) Funders - Government (Federal, State, & Local) (required) 500 character maximum
10) Earned Income (required) 500 character maximum

Grant Agreement Clauses

PLEASE NOTE: All applicant organization must complete the following certifications. If the certifications are found to have been completed inaccurately, the organization seeking support may be required to return any granted assets, and may be rendered ineligible for future support.

1) Religious Proselytizing Restriction (required)
Check "I confirm" to certify the following: The program described in this proposal is solely engaged in direct service provision. Exposure, adherence, or conversion to any religious doctrine is not required of the programs beneficiaries. If a grant is awarded, the organization will not use it for the purposes of religious proselytizing in any way.

I Confirm

2) Non-Violence and Anti-Terrorism Certification (required)
Check "I confirm" to certify the following: The organization (as well as any partners, re-grantees, or subsidiary or affiliated organizations) does not support, directly or indirectly, any terrorist activities or violence of any kind, nor does it employ or deal with any entities or individuals known to support terrorism. The organization certifies that it takes reasonable steps to ensure that grant funds are not ultimately distributed to terrorist organizations or for violent purposes; and takes reasonable steps to ensure that staff, board, and other volunteers have no dealings whatsoever with known terrorists or terrorist organizations.

I Confirm

3) Lobbying and Political Use Restrictions (required)
Check "I confirm" to certify the following: The organization will not knowingly use the grant, directly or indirectly, to influence legislation, to influence the outcome of any specific election for candidates to public office, to carry on any voter registration drive, to induce or encourage violations of law or public policy, to cause any improper private benefit to occur, or to make any grant to an individual other than as a part of the charitable activities in support of this project, nor to undertake any activity not in support of the project for which funding is requested.

I Confirm

4) Use of Funds (required)
Check "I confirm" to certify the following: The Organization will use the grant only for the purposes and activities specified in the grant application. If the Organization is dissolved, or if it is otherwise unable to use the grant for the specified project, the Organization will promptly return any unexpended grant funds to Verizon Foundation. If any portion of the grant is used for purposes other than the requested project, the Organization will promptly correct the error. If the misuse is not promptly corrected, Verizon Foundation may demand the return of the entire grant, and the Organization will return the grant to Verizon Foundation. If the Organization concludes that it is necessary to modify the plans for project in order to comply with requirements of any law or regulation affecting its responsibilities under this grant, or it becomes aware of facts or circumstances affecting its ability to implement the project or the propriety of such implementation, the Organization will promptly notify Verizon Foundation in writing, and together we will take the steps necessary to resolve the situation.

I Confirm

5) Confirmation of Charitable Intent (required)
Check "I confirm" to certify the following: We further certify that none of the proposed grant funds will be used to provide any direct benefit to The Verizon Foundation Company, to any Verizon Foundation employee or any employee's family member (except in the provision of charitable services or education available to the public at large), or to any staff member, board member, or donor to the Organization. No goods or services have been offered or promised in consideration for this charitable contribution. I further certify that to the best of my knowledge, information, and belief, the purpose of this grant is charitable and for the good of the community, and is not intended to fulfill business purposes or obligations of any kind including but not limited to offset, sales, or procurement commitments.

I Confirm

6) Acceptance of Review (required)
Check "I confirm" to certify the following: I understand that all applicants are subject to review of their representations in this application and (for grantees) their compliance with the grant agreement. I understand that the organization I represent may be required to return any granted assets and forfeit future funding eligibility if: (1) the review reveals any significant inaccuracies or violations of the policies stated above or (2) the organization does not cooperate with the review.

I Confirm

7) Board Review and Approval of this Application (required)
Check "I confirm" to certify the following: At least one officer of our nonprofit organization's board or executive of our nonprofit organization has reviewed this application, and the entire board has knowledge of and supports its submission.

I Confirm

8) Grant Accuracy Certification (required)
Check "I confirm" to certify the following: I certify that: (1) I completed this form, and the information I provided is complete and accurate, (2) the organization that I represent complies fully with the policies stated in the criteria and guidelines section on the introductory web page at the beginning of this application form, and (3) any assets awarded will be used only in the manner specified in this application.

I Confirm

9) Is this grant being requested by, or at the behest of, a government official? (required)

10) Will this grant be used to provide any benefit, including, but not limited to, meals, entertainment, or travel, to a government official? (required)

a) If so, provide a description of the benefit that will be provided, and the government officials that will receive the benefits. (required)

Enter "Not Applicable" if this grant does not apply to government officials.

2000 character maximum

b) If so, certify that any benefits provided to government officials will be in compliance with all applicable laws, rules, and regulations, including, but not limited to, federal, state, and local restrictions relating to campaign finance, lobbying, and government ethics. (required)

Select "Not Applicable" if this grant does not apply to government officials.