Brief Overview of Organization |
| Name of Organization* |
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| Address* |
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| City* |
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| State* |
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| ZIP* |
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| EIN* |
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| Contact Person Name* |
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| Contact Person Title* |
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| Contact Person Email* |
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| Contact Person Phone* |
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| Website URL |
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Organizational Mission Statement.* (please
limit to 1500 characters or approximately 250 words)* |
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Agency Current Annual Operating Budget Amount*
(fiscal budget details to also be included in "attachments" at end of form) |
$
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| Project Name* |
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Project Budget (if applicable) |
$
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Brief Summary of Project.* Statement of the problem, proposed solution, and the outcome (please
limit to 1500 characters or approximately 250 words) |
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Problem Statement and Objective(s)* |
- State the problem or challenge you were addressing, its impact on the community/clients/stakeholders, and the relationship to your agency's mission (10 points).
- Identify the objectives for the project and what you expected to achieve. Identify beneficiaries in your organization, client base, and community (10 points).
(please limit to 4000 characters or approximately 650 words)
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Project Description/The Solution* |
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Describe the project (e.g., implementation, timeline, major milestones, cost, impact on your organization's capacity during implementation, etc.) and why you think it is innovative. Include the following information:
- Describe the innovative use of technology and its integration into agency's operations, including staff, clients, and processes implemented around the use of the technology (15 points).
- Describe the project's funding, the impact on organizational capacity during development and implementation of the project, and a description of how your project demonstrates thought leadership (15 points).
(please limit to 8000 characters or approximately 1300 words)
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Qualitative and Quantitative Results/The Outcome* |
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Describe your results as compared to your stated objectives. Address the impact on your capacity to deliver service and the human impact to your clients and issue(s) being addressed. Use supporting data, statistics, graphs, and charts as needed.
- Describe how the solution increased organizational/program capacity (20 points).
- Describe and document how the project improved outcomes for your agency, clients, and/or community in both a qualitative and quantitative way (20 points).
- Describe how you will sustain the improvements over time, monitor the project’s effectiveness, and leverage it across other agency activities or share with other agencies (10 points).
(please limit to 6000 characters or approximately 1000 words)
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Attachments and Appendices |
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Your current fiscal year
budget must be submitted electronically. Please use the Browse button
to select and attach the appropriate files. We recommend scanning the
documents if electronic versions do not exist. Additional information
may also be attached as appendices.
Important:
Please do not submit files larger that 1MB (1 megabyte). If
your attachment is larger than this, please consider compressing it into
a .zip format, or call Lumity at 312.372.4872 for assistance. Accepted
file formats are Microsoft Office files (.doc, .xls, etc.), image
files (.jpg, .gif, etc.), and pdf and zip files.
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| Current Fiscal Year Budget* |
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| Appendices |
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