Whippet Health Foundation Grant Application
Provide the following information in this order.
For your convenience, you may choose either to copy and fill out this cover summary or create your own using the headings listed below.
Title of Proposal: ______________________________________________________
Requestor: ___________________________________________________________
Phone Number: __________________ FAX Number: ________________________
E-Mail ______________________________________________________________
Name of Co-Requestor: _________________________________________________
Phone Number: __________________ FAX Number: ________________________
E-Mail ______________________________________________________________
Name of Organization to which grant would be paid. Please list exact legal name:
____________________________________________________________________
Address of Organization:
____________________________________________________________________
Total Proposed Project/Program Budget: _____________________________
Amount Requested: ______________________
Duration of Project/Program: Start Date: _____________ End Date: ______________
The undersigned does hereby certify that the information set forth in this grant application is true and correct. I agree to accept responsibility for the conduct of the project and to provide the required project reports if an award is made as a result of this application.
Requestors Signature: ________________________________________________
Print Name/Title: _____________________________________________________
Date: ________________________
Co-Requestors Signature: _____________________________________________
Print Name/Title: _____________________________________________________
Date: ________________________
An officer of the organizations governing body must sign this application:
The undersigned, an authorized officer of the organization, does hereby certify that the information set forth in this grant application is true and correct. I agree to accept responsibility for the conduct of the project and to provide the required project reports if an award is made as a result of this application.
Authorized Officer Signature: ___________________________________________
Print Name/Title: ____________________________________________________
Date: ________________________
Title of Proposal: ______________________________________________________
Requestor: ___________________________________________________________
Phone Number: __________________ FAX Number: ________________________
E-Mail ______________________________________________________________
Name of Co-Requestor: _________________________________________________
Phone Number: __________________ FAX Number: ________________________
E-Mail ______________________________________________________________
Name of Organization to which grant would be paid. Please list exact legal name:
____________________________________________________________________
Address of Organization:
____________________________________________________________________
Total Proposed Project/Program Budget: _____________________________
Amount Requested: ______________________
Duration of Project/Program: Start Date: _____________ End Date: ______________
The undersigned does hereby certify that the information set forth in this grant application is true and correct. I agree to accept responsibility for the conduct of the project and to provide the required project reports if an award is made as a result of this application.
Requestors Signature: ________________________________________________
Print Name/Title: _____________________________________________________
Date: ________________________
Co-Requestors Signature: _____________________________________________
Print Name/Title: _____________________________________________________
Date: ________________________
An officer of the organizations governing body must sign this application:
The undersigned, an authorized officer of the organization, does hereby certify that the information set forth in this grant application is true and correct. I agree to accept responsibility for the conduct of the project and to provide the required project reports if an award is made as a result of this application.
Authorized Officer Signature: ___________________________________________
Print Name/Title: ____________________________________________________
Date: ________________________
Grant Application
Page 2
GENERAL INSTRUCTIONS AND INFORMATION
Submit Grant Applications to the following address:
NARRATIVE
PLEASE PROVIDE THE FOLLOWING INFORMATION IN THE ORDER PRESENTED BELOW.
(No more than ten narrative pages, plus no more than one page of references; twelve point font; one inch borders; include applicants name on the top of each page.)
Page 2
GENERAL INSTRUCTIONS AND INFORMATION
- Type and single space all proposals (12 point font)
- Provide all of the information in the order listed
- All questions must be completed fully
- Submit ten copies of the application with numbered pages
- Do not send videotapes
- This Grant Application form is to be used for all types of proposals. We retain the option to require additional information from applicants.
- The Whippet Health Foundation, Inc. shall be entitled to 10% of the Net Revenues of any invention resulting from a study they fund
Submit Grant Applications to the following address:
WHIPPET HEALTH FOUNDATION, INC.
Cathy Gaidos, Secretary
10177 Blue River Hills Road
Manhattan, KS 66503
Cathy Gaidos, Secretary
10177 Blue River Hills Road
Manhattan, KS 66503
NARRATIVE
PLEASE PROVIDE THE FOLLOWING INFORMATION IN THE ORDER PRESENTED BELOW.
(No more than ten narrative pages, plus no more than one page of references; twelve point font; one inch borders; include applicants name on the top of each page.)
- Complete Project Description
• Describe the importance of the proposed research and relevance to the Foundations mission statement
and interests
• Description of project goals and measurable objectives
• Need for the project and how the need was determined
• Expected outcomes
• Plans and timetables for implementation
• Staffing requirements
• Means for evaluating the projects results
• Projects actual or projected expenditures and revenues for the project period
- Budget
• Budget should include detailed breakdown of all items and estimated cost to the Foundation.
• The Foundation does not pay for administrative overhead.
• Be brief but as accurate as possible, showing budget figures for each year, if multi-year. - Duration of project. All projects are subject to yearly review.
- Explain how you plan to evaluate the project.
- Is this request part of a larger ongoing program? Include previous and proposed funding by all sources.