The Harley-Davidson Foundation Online Grant Application Instructions

Size: px
Start display at page:

Download "The Harley-Davidson Foundation Online Grant Application Instructions"

Transcription

1 The Harley-Davidson Foundation Online Grant Application Instructions The following categories will need to be completed in order to submit your organization s online grant application to The Harley-Davidson Foundation: Organizational Information Online Login Organization Contact Information Mission & Goals Organization Discrimination Policy Employee & Volunteer Totals Primary Contact Category of Organization Proposal Information Proposal/Request Information Project/Program Description Evaluation Funding Considerations Proposal/Request Contact Harley-Davidson Contact Proposal Categories Gender Served Age Group Served Ethnicity Served Geographical Area Served Program Area Served Population Served Authorization Statement Permission to Submit Proposal Attachments IRS 990 IRS Determination Letter Independent Auditors Report Program Budget Organizational Budget Board of Directors List A full description of the information needed for each category is listed in the pages that follow. Note: Use this document as a checklist before starting the application. 1

2 Organizational Information Online Login: Username and Password Create a generic login if you have multiple grant writers needing access to the proposal. Organization Contact Information: Tax ID Number Organization Legal Name Address: City, State, Postal Code Phone Number (with Area Code) Fax Number (If Applicable) Website Address (If Applicable) Total Operating Budget Mission & Goals: Mission Statement & Organizational Goals (250 words or less) Organization Discrimination Policy: Choose One: Has Policy or Does Not Have Policy Employee & Volunteer Totals: Total Number of Full Time Employees Total Number of Part Time Employees Total Number of Volunteers Total Number of Harley-Davidson Volunteers Primary Contact: Prefix First Name Last Name Title Address Phone Number Extension (If Applicable) Category of Organization: Choose the primary option from the following: Education Environment Health 2

3 Proposal Information Proposal/Request Information: Project Title One Sentence Summary of your Proposal Request Amount Project Budget - Total Amount of Project/Proposal Project Start Date Project End Date Project/Program Description: (NOT required for general operating requests) (350 Words) Abstract: Briefly describe the proposed program, how it relates to the organization's mission, capacity to carry out the program and who will benefit from the program. Outline the strategy/methodology and timeline to be used in the development and implementation of the program. Evaluation: (300 Words) Describe the results expected to be achieved. Explain how the organization will measure the program and what criteria you will use to indicate success. Funding Considerations: (250 Words) Describe plans for obtaining other funding needed to carry out the project/program or organizational goals, including amounts requested of other funders. If the project/program is expected to continue beyond the grant period, describe plans for ensuring continued funding after the grant period. List the top five funders of this project (if applying for a program grant) or organization (if applying for general operating support) in the previous fiscal year, the current year, and those pending for the next fiscal year. 3

4 Proposal/Request Contact: Is the primary contact the same as the request/proposal contact? If yes, click the box and do not enter information into the data fields. If no, enter new contact information in the data fields. Prefix First Name Last Name Title Address Phone Number Extension (If Applicable) Harley-Davidson Contact: Is a Harley-Davidson staff member associated with the proposal? If yes, enter contact information in the data fields. If no, leave fields blank. Prefix First Name Last Name Title Address Phone Number Extension (If Applicable) 4

5 Proposal Categories Gender Served: From the options below, select those that match the gender(s) served by your proposal: (one selection) None All Females Males Age Group Served: From the options below, select those that match the age group served by your proposal: (up to three selections) Adults Children/Youth 4-12 Elderly 60+ General Public Infants/Babies 0-3 Teens/Young Adults Ethnicity Served: Please read carefully. From the options below, select those that match the ethnicity served by your proposal: (up to two selections) Note: Only choose an ethnicity below if the total ethnic group equates to more than 51% of those served by the project. Choose General Minority if your organization serves a mix of ethnic groups that total 51% of the population served by the project. Ethnicity Not Tracked African American Asian American Caucasian General Minority Hispanic Native American 5

6 Geographical Area Served: From the options below, select those that match the geographical area served by your proposal: (up to two selections) Valley View, OH Plano, TX Chicago, IL Kansas City, MO Menomonee Falls, WI Milwaukee, WI Milwaukee, WI Washington Park Milwaukee, WI Menomonee Valley Tomahawk, WI Wauwatosa, WI York, PA Yucca, AZ Mohave County, AZ Program Area Served: From the options below, select the category that best fits your program: (one selection) Education Continuing Education GED, Technical Schools Education Arts Education Education Employment Enablers Education Higher Education 4-Year Colleges Education Kindergarten 12 th Grade Education Literacy Education Preschool Education Youth Development (mentors/tutors, after school programs, college readiness) Environment Economic Development Environment Botanic & Horticulture Activities Parks Environment Conservation Environment Environmental Education Environment Neighborhood Revitalization (Houses) Health Basic Needs - Food /Clothing Health Health Support Services Health Mental Health Treatment & Services Health Public Health & Wellness Education 6

7 Population Served: From the options below, select those that best fit the population served by your proposal: (up to two selections) Blind/Visually Disabled Disabled General Community GLBT Hearing Impaired/Deaf Homeless Poor/Economically Disadvantaged Veterans Authorization Statement By completing and submitting this request for funding, you are acknowledging that: The chief executive officer has authorized this request. You are authorized, by the requesting organization, to submit this request for funding. Attachments Attachments List: For your application to be considered complete, the following attachments must be attached before submission: IRS 990 Most current year IRS 990 Acceptable Format: PDF Only IRS Determination Letter - Your non-profit exempt letter from the IRS Independent Auditors Report - Audit of your most current fiscal year budget created by an independent auditor. Program Budget - Project/Program budget for the proposal Organization Budget Organization budget for most current year Board of Directors List - A list of your current board members, position titles, and any compensation they receive for their board membership. 7

8 Grant Evaluation - A report of your program's outcomes for the past year. (Required only if you have previously received a grant from our organization.) 8

WISCONSIN COMMON GRANT APPLICATION FORM (Revised March 2006)

WISCONSIN COMMON GRANT APPLICATION FORM (Revised March 2006) WISCONSIN COMMON GRANT APPLICATION FORM (Revised March 2006) The Common Grant Application (CGA) can be used for all types of proposals: special projects, capital and general operating support. Please note

More information

Common Application Form

Common Application Form New York/New Jersey Area Application Form The foundations and corporations that developed this common application form hope it will help nonprofit organizations in the New York/New Jersey area save time

More information

GREATER PHILADELPHIA JUNIOR GOLF FOUNDATION FUND GRANT APPLICATION COVER SUMMARY

GREATER PHILADELPHIA JUNIOR GOLF FOUNDATION FUND GRANT APPLICATION COVER SUMMARY GRANT APPLICATION COVER SUMMARY Complete this form by either filling-in the information on this sheet or by reproducing the form exactly. 1. Legal Name of organization: Address, Telephone and Fax: Email

More information

SAMPLE APPLICATION PDF - Strategic Grant Project Support for Public Schools, Universities/Colleges, Governmental Units, & Religious Entities

SAMPLE APPLICATION PDF - Strategic Grant Project Support for Public Schools, Universities/Colleges, Governmental Units, & Religious Entities SAMPLE APPLICATION PDF - Strategic Grant Project Support for Public Schools, Universities/Colleges, Governmental Units, & Religious Entities IMPORTANT: Below are a series of questions that will be asked

More information

Mrs. H.L. (Ruth Ray Hunt Memorial Fund Grant Cycle Spring 2014 Online Application Tips and FAQs

Mrs. H.L. (Ruth Ray Hunt Memorial Fund Grant Cycle Spring 2014 Online Application Tips and FAQs ABOUT THE COMMON GRANT APPLICATION In an effort to respond to requests from local nonprofit organizations, Dallas Women s Foundation has joined a group of funders in North Texas and developed the Common

More information

SMALL BUSINESS MOBILIZATION LOAN APPLICATION

SMALL BUSINESS MOBILIZATION LOAN APPLICATION SMALL BUSINESS MOBILIZATION LOAN APPLICATION All applicants must complete the Application in its entirety. The Guidelines section contains information on the Loan Program Parameters, the Loan Applications

More information

CREW Philadelphia Philanthropic Partner Application General Information, Application & Instructions GENERAL INFORMATION

CREW Philadelphia Philanthropic Partner Application General Information, Application & Instructions GENERAL INFORMATION CREW Philadelphia Philanthropic Partner Application General Information, Application & Instructions GENERAL INFORMATION CREW Philadelphia (crewphiladelphia.org) CREW Philadelphia provides opportunities

More information

Neighborhood Checkup

Neighborhood Checkup Promise Neighborhoods Research Consortium (PNRC) Neighborhood Checkup Survey of Current Supports for Successful Youth Development First, we are going to ask you a few questions about your. For this survey,

More information

2008 Solano-Napa United Way Health Fund Grants Request for Proposal and Application Form

2008 Solano-Napa United Way Health Fund Grants Request for Proposal and Application Form 2008 Solano-Napa United Way Health Fund Grants Request for Proposal and Application Form ABOUT The Solano-Napa United Way Health Fund was created in partnership by the United Way of the Bay Area and Solano

More information

Supervisor Guide For Work Study Students 2014 2015

Supervisor Guide For Work Study Students 2014 2015 Supervisor Guide For Work Study Students 2014 2015 THE CAREER DEVELOPMENT CENTER AND STUDENT EMPLOYMENT... 2 WHAT IS FEDERAL WORK STUDY?... 2 THE FINANCIAL AID OFFICE... 2 WHY HIRE WORK STUDY STUDENTS?...

More information

Warren County Philanthropic Partnership PO Box 218 Indianola, IA 50125 www.warrencountypp.org

Warren County Philanthropic Partnership PO Box 218 Indianola, IA 50125 www.warrencountypp.org Grant Application Overview Warren County Philanthropic Partnership PO Box 8 Indianola, IA 0 www.warrencountypp.org Mission Statement: The mission of the Warren County Philanthropic Partnership is to promote

More information

Florida 4-H Online Instructional Manual

Florida 4-H Online Instructional Manual The Florida 4-H Youth Development Program is introducing the 4-H Online member enrollment. This will address the concerns of reduced staff support in many of our county offices and to modernize the capabilities

More information

Application for Free Home Repairs

Application for Free Home Repairs Application for Free Home Repairs Name of Homeowner: Date of Birth: Gender Male Female Is this a female headed household? Is this a grandparent headed household? Street Address: City: County: Zip Marital

More information

APPLICATION FOR NON-EMPLOYEES

APPLICATION FOR NON-EMPLOYEES APPLICATION FOR NON-EMPLOYEES NorthEast Treatment Centers is an Equal Opportunity company and does not discriminate on the basis of race, color, religion, gender, age, ethnic or national origin, handicap,

More information

APPENDIX 1: SURVEY. Copyright 2010 Major, Lindsey & Africa, LLC. All rights reserved.

APPENDIX 1: SURVEY. Copyright 2010 Major, Lindsey & Africa, LLC. All rights reserved. APPENDIX 1: SURVEY Major, Lindsey & Africa Partner Compensation Survey (2010) Dear : Major, Lindsey & Africa invites you to participate in our 2010 MLA Partner Compensation Survey. This Survey, which is

More information

Education. Date of discharge (if applicable) [Required] Total number of service years. [Required] Total years and months active duty

Education. Date of discharge (if applicable) [Required] Total number of service years. [Required] Total years and months active duty Veteran Scholarships Application Basic Information [Required] Contact Information - must be 10-15 digits long and may include only numbers, hyphens, and spaces. - name@myschool.edu First name: Middle initial:

More information

Certified Peer Counselor Training Application

Certified Peer Counselor Training Application Certified Peer Counselor Training Application Instructions Please type or print clearly. All sections of the form must be completed for the application to be accepted. These instructions explain how to

More information

A Guide to the ABAG Grant Proposal Format

A Guide to the ABAG Grant Proposal Format A Guide to the ABAG Grant Proposal Format The following document is not a form to be completed, but an outline and advice for writing a grant proposal developed by a task force of grantmakers and nonprofit

More information

Howell Township Public Schools: Instructions for Online Student Registration

Howell Township Public Schools: Instructions for Online Student Registration Howell Township Public Schools: Instructions for Online Student Registration Introduction This document is a step-by-step guide to the online forms used for student registration. These online forms collect

More information

Attach a copy of your current California LVN license with this application.

Attach a copy of your current California LVN license with this application. CAREER LADDER (LVN TO RN) APPLICATION Incomplete Applications will not be processed Print Name: Last First Social Security # XXX-XX PCC ID# PCC student Identification numbers are not accepted in place

More information

LOAN APPLICATION. Mission. Program Information: Do you qualify?

LOAN APPLICATION. Mission. Program Information: Do you qualify? LOAN APPLICATION Mission The mission of Economic Development and Financing Corporation (EDFC) is Connecting money and ideas with entrepreneurs to create sustainable prosperity in Lake and Mendocino Counties.

More information

PRACTITIONER REGISTRY APPLICATION

PRACTITIONER REGISTRY APPLICATION Pract Application Rev 06/23/2014 Page 1 PRACTITIONER REGISTRY APPLICATION The Registry verifies trainers, registers training, and tracks the professional development of both practitioners and trainers.

More information

Dual /Joint Enrollment Application Checklist Student Name: SSN:

Dual /Joint Enrollment Application Checklist Student Name: SSN: HIGH SCHOOL PROGRAMS Dual / Joint Enrollment Dual /Joint Enrollment Application Checklist Student Name: SSN: HIGH SCHOOL COUNSELOR Phone: Listed below is the required admissions material for students to

More information

LINCOLN SCHOOL DISTRICT 156 410 157 th Street Calumet City, Illinois 60409-4798

LINCOLN SCHOOL DISTRICT 156 410 157 th Street Calumet City, Illinois 60409-4798 LINCOLN SCHOOL DISTRICT 156 410 157 th Street Calumet City, Illinois 604094798 Dear Applicant: APPLICATION FOR EMPLOYMENT FOR CERTIFIED PERSONNEL We welcome your application for employment in Lincoln Elementary

More information

DELCO Home Health Care Fund Grant Application

DELCO Home Health Care Fund Grant Application DELCO Home Health Care Fund Grant Application Before completing the grant application, be sure to: Read all instructions thoroughly before beginning. Be strategic make sure your goals, objectives and amount

More information

Application for Admission

Application for Admission Eastern Oklahoma State College - Nursing Division Application for Admission Generic Nursing Program (4 semesters): Application period is January 1st through February 15th Transition with LPN or EMTP Licensure

More information

Existing Family Guide for enrolling into Colorado 4-H and the official Colorado online system 4HOnline web site is located at: https://co.4honline.

Existing Family Guide for enrolling into Colorado 4-H and the official Colorado online system 4HOnline web site is located at: https://co.4honline. Existing Family Guide for enrolling into Colorado 4-H and the official Colorado online system 4HOnline web site is located at: https://co.4honline.com 1) Select I have a profile Enter email and password

More information

The Math TLC Master s in Mathematics for Secondary Teachers Program

The Math TLC Master s in Mathematics for Secondary Teachers Program Math TLC Master s Application Form Page 1 The Math TLC Master s in Mathematics for Secondary Teachers Program Electronic Application Form Instructions Save your completed application a filename of the

More information

Community Perception Survey

Community Perception Survey Building Relationships of Trust Community Perception Survey SUBMISSION INSTRUCTIONS (Complete the survey, save the document and email to jluther@diamondhead.ms.gov ) You may also print out, mail or hand

More information

ACCOUNTABILITY COURT DATA. Ren Yang Hafner, Operations Analyst Statistical Analysis Center Criminal Justice Coordinating Council

ACCOUNTABILITY COURT DATA. Ren Yang Hafner, Operations Analyst Statistical Analysis Center Criminal Justice Coordinating Council ACCOUNTABILITY COURT DATA Ren Yang Hafner, Operations Analyst Statistical Analysis Center Criminal Justice Coordinating Council Nov. 15, 2013 Adult Felony Drug & Mental Health Court Adult Felony Drug Court

More information

Succession Planning: Safeguarding the future of your organization. Northwest Harvest Annual Conference April 25, 2014

Succession Planning: Safeguarding the future of your organization. Northwest Harvest Annual Conference April 25, 2014 Succession Planning: Safeguarding the future of your organization Northwest Harvest Annual Conference April 25, 2014 Presenters: Leon Brauner Ocean Shores Food Bank Yvonne Freitas McGookin 501 Commons

More information

RONALD E. MCNAIR SCHOLARS PROGRAM APPLICATION

RONALD E. MCNAIR SCHOLARS PROGRAM APPLICATION RONALD E. MCNAIR SCHOLARS PROGRAM APPLICATION RONALD E. MCNAIR SCHOLARS PROGRAM 1011 HOYT HALL, EASTERN MICHIGAN UNIVERSITY YPSILANTI, MI 48197 / TEL. (734) 487-8240 Date Applying for program starting

More information

PERSONAL INFORMATION - Please list full legal name as it appears on your Social Security card. Name: Last First Middle Initial

PERSONAL INFORMATION - Please list full legal name as it appears on your Social Security card. Name: Last First Middle Initial Updated 11/2015 Midstate Independent Living Consultants, Inc. 3262 Church Street, Stevens Point, WI 54481 715-344-4210 V/TTY 800-382-8484 V/TTY 715-344-4414 FAX -------------------------------------------------------------------------------------------------

More information

LCU ONLINE STUDENT APPLICATION

LCU ONLINE STUDENT APPLICATION FOR LCU OFFICE USE ONLY STUDENT ID CAMPUS CODE DATE RECEIVED DATE APPROVED DATE ENTERED INTO C-R ENTERED BY initial ROLES STUDENT FACULTY HOST PASTOR director DATE ASSESSED ASSESSED BY designated student

More information

Certified Peer Counselor Training Application

Certified Peer Counselor Training Application Certified Peer Counselor Training Application Instructions Please type or print clearly. All sections of the form must be completed for the application to be accepted. These instructions explain how to

More information

Mississippi Teacher Fellowship Program Application

Mississippi Teacher Fellowship Program Application Mississippi Teacher Fellowship Program Application Overview In 1998, the Mississippi Legislature passed House Bill 609 which addresses the critical teacher shortage in the state, which Section 13 of this

More information

Office of Human Resources 8470 North Overfield Road Coolidge, AZ 85128 CENTRAL ARIZONA COLLEGE EMPLOYMENT APPLICATION

Office of Human Resources 8470 North Overfield Road Coolidge, AZ 85128 CENTRAL ARIZONA COLLEGE EMPLOYMENT APPLICATION Office of Human Resources 8470 rth Overfield Road Coolidge, AZ 85128 CENTRAL ARIZONA COLLEGE EMPLOYMENT APPLICATION AN AFFIRMATIVE ACTION AND EQUAL OPPORTUNITY EMPLOYER Phone: (520) 494-5235 www.centralaz.edu

More information

Delaware County CHDO CERTIFICATION APPLICATION

Delaware County CHDO CERTIFICATION APPLICATION Delaware County CHDO CERTIFICATION APPLICATION Date of Submission: Name of Organization: Executive Director: Board President: Email: Email: Address: City: State: Zip: Application Preparer: Email: Title:

More information

Health of Wisconsin. Children and young adults (ages 1-24) B D. Report Card 2013. July 2010

Health of Wisconsin. Children and young adults (ages 1-24) B D. Report Card 2013. July 2010 Health of Wisconsin Summary Grades Life stage Health grade Health disparity grade Infants (less than 1 year of age) C D Children and young adults (ages 1-24) B D Working-age adults (ages 25-64) B C Older

More information

Monterey County Behavioral Health 2013 Satisfaction Survey Outcomes

Monterey County Behavioral Health 2013 Satisfaction Survey Outcomes SERVICE AREA - DUAL DIAGNOSIS TREATMENT DTH Co-occuring Disorder SD (BVCSOCSDV) DTH Santa Lucia (CDCSOC) Youth Surveys High Performing Indicators (75% and above) Low Performing Indicators (below 75%) Positive

More information

How to Apply for Admission Online

How to Apply for Admission Online How to Apply for Admission Online From the Blackhawk Technical College website, you may access the online application from within the Career Transitioning or Admissions areas. Click on Apply Online. You

More information

Move on When Ready Application Checklist Student Name: SSN:

Move on When Ready Application Checklist Student Name: SSN: 1 HIGH SCHOOL PROGRAMS Dual / Joint Enrollment Move on When Ready Application Checklist Student Name: SSN: HIGH SCHOOL COUNSELOR Phone: Listed below is the required admissions material for students to

More information

Rush Center Statewide LGBT Community Survey Results Prepared for Georgia Equality and The Health initiative by the Shapiro Group

Rush Center Statewide LGBT Community Survey Results Prepared for Georgia Equality and The Health initiative by the Shapiro Group Rush Center Statewide LGBT Community Survey Results Prepared for Georgia Equality and The Health initiative by the Shapiro Group In an effort to better understand the needs of gay, lesbian, bisexual and

More information

Funding Areas. Health (1 st Quarter) Education (2 nd Quarter) Civic/Community (3 rd Quarter) Human Services (4 th Quarter)

Funding Areas. Health (1 st Quarter) Education (2 nd Quarter) Civic/Community (3 rd Quarter) Human Services (4 th Quarter) Funding Areas Health (1 st Quarter) Education (2 nd Quarter) Civic/Community (3 rd Quarter) Human Services (4 th Quarter) Human Services Goal: Toward addressing the challenges created by poverty and other

More information

The PTA s new membership website database and dues reporting system

The PTA s new membership website database and dues reporting system M3 The PTA s new membership website database and dues reporting system State Level Actions from Task Menu M3 CAPABILITIES The State must authorize a user to have access to M3. The State s authorized users

More information

APPLICATION Detroit Grocery Incubator Grocery Leadership Fellowship

APPLICATION Detroit Grocery Incubator Grocery Leadership Fellowship APPLICATION Detroit Grocery Incubator Grocery Leadership Fellowship The Grocery Leadership Fellowship is designed to assist individuals develop their management skills and industry knowledge in order to

More information

Baccalaureate Degree Program. Application for Admission & Readmission RN-BSN Track

Baccalaureate Degree Program. Application for Admission & Readmission RN-BSN Track Baccalaureate Degree Program Application for Admission & Readmission RN-BSN Track Please read the application carefully and fill it in completely. Incomplete applications will not be accepted. Admission

More information

BUSINESS LEADERSHIP ACADEMY APPLICATION

BUSINESS LEADERSHIP ACADEMY APPLICATION BUSINESS LEADERSHIP ACADEMY APPLICATION 500 E. 61st Street CHICAGO, IL 60637 The Sunshine Enterprises Business Leadership Academy APPLICATION DEADLINE: Must Be turned in 2 weeks prior to first day of class

More information

Idaho Peer Support Specialist Training Application

Idaho Peer Support Specialist Training Application Idaho Peer Support Specialist Training Application This application must be received no later than July 31, 2015 Before completing this application, please first review the minimum requirements for applicants

More information

How to Get Set Up for the 2014 BE-180 and Request an Extension if Needed

How to Get Set Up for the 2014 BE-180 and Request an Extension if Needed How to Get Set Up for the 2014 BE-180 and Request an Extension if Needed For instructions on how to get set up for the 2014 BE-180 and to request an extension if one is needed, click on one of the links

More information

SCILC Statewide Needs Assessment

SCILC Statewide Needs Assessment SCILC Statewide Needs Assessment Thank you for taking the time to complete this survey. It is designed to measure barriers in the community for people with disabilities so that the SC Statewide Independent

More information

Central Application Service for Physician Assistants. Application Instructions 2016-2017 CASPA. April 27, 2016- March 1, 2017

Central Application Service for Physician Assistants. Application Instructions 2016-2017 CASPA. April 27, 2016- March 1, 2017 Central Application Service for Physician Assistants Application Instructions 2016-2017 April 27, 2016- March 1, 2017 CASPA PO Box 9112 Watertown, MA 02471 617.612.2080 portal.caspaonline.org 1 CASPA CONTACT

More information

About Social Venture Partners and Our Investment Process

About Social Venture Partners and Our Investment Process 12900 Preston Road Suite 1220 Dallas, TX 75230 www.svpdallas.org TEL 214.855.5520 DoGoodBetter@svpdallas.org What change are you striving for? Is there something holding you back? What could you do if

More information

2016 Homeless Count Results Los Angeles County and LA Continuum of Care. Published by: Los Angeles Homeless Services Authority May 4, 2016 1

2016 Homeless Count Results Los Angeles County and LA Continuum of Care. Published by: Los Angeles Homeless Services Authority May 4, 2016 1 2016 Homeless Count Results Los Angeles County and LA Continuum of Care Published by: Los Angeles Homeless Services Authority May 4, 2016 1 Why Do We Count? The Homeless Count seeks to answer key questions

More information

Official Paul Quinn College Application for Admission

Official Paul Quinn College Application for Admission Official Paul Quinn College Application for Admission APPLICATION CHECKLIST This is your invitation. Show us who you are, and we ll show you what we re all about. Applying to PQC is a lot like it is at

More information

REBUILDING YOUR CREDIT

REBUILDING YOUR CREDIT REBUILDING YOUR CREDIT REGISTRATION FORM Pre-Registration is REQUIRED There is a $10 fee for the course per household and a $20 per person fee for the tri-merged credit report. You may also bring a copy

More information

March 24, 2014. Massachusetts Association of Hispanic Attorneys 16 Beacon Street Boston, MA 02108

March 24, 2014. Massachusetts Association of Hispanic Attorneys 16 Beacon Street Boston, MA 02108 HAMPDEN COUNTY LAWYERS FOR JUSTICE, INC. 95 State Street, Suite 1026 Springfield, MA 01103-2037 Telephone; (413) 732-7110 FAX: (413) 732-6545 E-mail: hampdenba@gmail.com March 24, 2014 Massachusetts Association

More information

QUEST BIBLE INSTITUTE (QBI) APPLICATION

QUEST BIBLE INSTITUTE (QBI) APPLICATION Please type, or print using ball point pen, YOUR LEGAL NAME (no nicknames, please). 1. Last First Middle Male Female Preferred Name: 2. Indicate interest to which you are applying: Ministerial Diploma

More information

Associate Degree in Nursing Program-- Application for Admission SPRING 2017 NEW REGISTRATION PROCESS

Associate Degree in Nursing Program-- Application for Admission SPRING 2017 NEW REGISTRATION PROCESS Associate Degree in Nursing Program-- Application for Admission SPRING 2017 NEW REGISTRATION PROCESS APPLICATION INSTRUCTIONS FOR APPLICANTS AND REAPPLICANTS DEADLINE IS AUGUST 5, 2016 BY 2:00PM NO EXCEPTIONS

More information

AZ Division of Children, Youth and Families External Data Questions

AZ Division of Children, Youth and Families External Data Questions AZ Division of Children, Youth and Families External Data Questions Goals: What do we A. What is the unemployment rate by district, county and statewide Unemployment rates: Each county: State: Aggregate

More information

Ending Veteran and Veteran Family Homelessness: The Homeless Veteran Supported Employment Program (HVSEP)

Ending Veteran and Veteran Family Homelessness: The Homeless Veteran Supported Employment Program (HVSEP) Ending Veteran and Veteran Family Homelessness: The Homeless Veteran Supported Employment Program (HVSEP) Carma A. Heitzmann, Ph.D. National Program Manager HVSEP VHA Homeless Program Office carma.heitzmann@va.gov

More information

APPLICATION FOR ADMISSION TO LORAIN COUNTY COMMUNITY COLLEGE 1005 N Abbe Road Elyria OH 44035 Elyria (440) 366-4032 Toll Free (800) 995-5222

APPLICATION FOR ADMISSION TO LORAIN COUNTY COMMUNITY COLLEGE 1005 N Abbe Road Elyria OH 44035 Elyria (440) 366-4032 Toll Free (800) 995-5222 APPLICATION FOR ADMISSION TO LORAIN COUNTY COMMUNITY COLLEGE 1005 N Abbe Road Elyria OH 44035 Elyria (440) 366-4032 Toll Free (800) 995-5222 Print clearly using a blue or black ballpoint pen. Complete

More information

Bachelor of Science Nursing (RN to BSN)

Bachelor of Science Nursing (RN to BSN) Bachelor of Science Nursing (RN to BSN) Application Packet The Bachelor of Science in Nursing program (BSN) is accredited by the Commission on Collegiate Nursing Education (CCNE). Olympic College Mission

More information

ANNUAL REPORT 2013. Improving Children s Lives Since 1966

ANNUAL REPORT 2013. Improving Children s Lives Since 1966 ANNUAL REPORT 2013 Improving Children s Lives Since 1966 CONTENTS Message from the CEO.. pg 3 Foster Care and Adoptions... pg 4 Residential Treatment Foster Care. pg 6 Financial Information pg 9 Our Mission:

More information

Summer Research-Early Identification Program Online Application

Summer Research-Early Identification Program Online Application Summer Research-Early Identification Program Online Application Read This Before You Register What are the browser requirements?... 1 What are the Leadership Alliance SR-EIP eligibility requirements?...

More information

Common Grant Application User Guide

Common Grant Application User Guide Common Grant Application User Guide Welcome to the Washington Regional Association of Grantmakers Common Grant Application (CGA). This user guide was revised in 2012 to reflect the changes in the CGA that

More information

MICROLOAN APPLICATION CHECKLIST (Loans $50,000)

MICROLOAN APPLICATION CHECKLIST (Loans $50,000) checklist. INSTRUCTIONS Please complete this application and provide the information requested on the application checklist. Confirmation of receipt of a request will be made within approximately 5 business

More information

CASE MANAGEMENT INVENTORY OF SUPPORT SERVICES For Adults

CASE MANAGEMENT INVENTORY OF SUPPORT SERVICES For Adults COMMONWEALTH OF PENNSYLVANIA BUREAU OF DRUG and ALCOHOL PROGRAMS Division of Treatment CASE MANAGEMENT INVENTORY OF SUPPORT SERVICES For Adults NAME : SSN: ADDRESS PHONE: (Street) ISS Interval Scores CIS

More information

Credentialing Application for Dental Services and/or Anesthesia Service

Credentialing Application for Dental Services and/or Anesthesia Service STATE OF TENNESSEE DEPARTMENT OF INTELLECTUAL AND DEVELOPMENTAL DISABILITIES Credentialing Application for Dental Services and/or Anesthesia Service Provider qualification specified in the Home and Community

More information

Application for Vocational Rehabilitation Services

Application for Vocational Rehabilitation Services Strong Families Make a Strong Kansas Application for Vocational Rehabilitation Services Is Vocational Rehabilitation the right program for you? Some brief information about the Vocational Rehabilitation

More information

I. Dual Credit General Information and Checklist

I. Dual Credit General Information and Checklist DUAL CREDIT APPLICATION PAPERWORK I. Dual Credit General Information and Checklist A. General Information Dual Credit is the broad term for various opportunities for students to take college coursework

More information

Background Information

Background Information Background Information Occupation Expert for: The goal of this project is to get accurate, up-to-date information on the occupation of from a diverse

More information

Transportation Construction Apprenticeship Readiness Training T.C.A.R.T. Cell Phone Date of Birth (mm/dd/yyyy) Gender: Male

Transportation Construction Apprenticeship Readiness Training T.C.A.R.T. Cell Phone Date of Birth (mm/dd/yyyy) Gender: Male PROGRAM APPLICATION Host CBO: Applicant # Last Name Address Home Phone SS# Email First Name City/State/Zip Cell Phone Date of Birth (mm/dd/yyyy) Middle Initial I have the legal right to work in the US.

More information

Youth Waiting Residential Treatment Survey Results

Youth Waiting Residential Treatment Survey Results Introduction Youth Waiting Residential Treatment Survey Results Bernalillo County has been interested in assessing their special needs population for several years. A particular population of interest

More information

COLORADO COMBINED CAMPAIGN College, University and State Service Organization (CU/SSO) Application

COLORADO COMBINED CAMPAIGN College, University and State Service Organization (CU/SSO) Application COLORADO COMBINED CAMPAIGN College, University and State Service Organization (CU/SSO) Application January 5, 2015 To all Prospective Participating Colleges, Universities and State Service Organizations:

More information

Street Address Address Line 2 City State /

Street Address Address Line 2 City State / Owner Information Name * First Middle Last Social Security Number * Date of birth * /MM /DD YYYY Home Phone # * -### -### #### Business Phone # * -### -### #### Cell Phone * -### -### #### Email Address

More information

CREDIT & BUDGET COUNSELING CHECKLIST. Completed Housing Intake Forms Including Budget Sheet, Release of Information, & Privacy Statement

CREDIT & BUDGET COUNSELING CHECKLIST. Completed Housing Intake Forms Including Budget Sheet, Release of Information, & Privacy Statement CREDIT & BUDGET COUNSELING CHECKLIST PLEASE BRING EACH OF THE FOLLOWING TO YOUR APPOINTMENT: Completed Housing Intake Forms Including Budget Sheet, Release of Information, & Privacy Statement Copy of Pay

More information

Paul Ogle Foundation, Inc. Grant Application

Paul Ogle Foundation, Inc. Grant Application Section I - Organization Information Paul Ogle Foundation, Inc. Grant Application Organization Name: Application Date: Federal Tax ID: - Date Incorporated: Date of 501(c)(3) Letter: Address: Address: City:

More information

Veterans Multi-Service Center

Veterans Multi-Service Center Veterans Multi-Service Center VTF-IT Program Details Please make sure to read this document in its entirety, and verify that you understand the program details by signing at the bottom and returning a

More information

Engineering and Construction Management Program

Engineering and Construction Management Program Milwaukee Metropolitan Sewerage District s Engineering and Construction Management Program Contractor Training Series Free Program Designed for Business Owners or Key Associates of Small, Women, Minority,

More information

CITY OF TULLAHOMA SMALL BUSINESS REVOLVING LOAN FUND

CITY OF TULLAHOMA SMALL BUSINESS REVOLVING LOAN FUND CITY OF TULLAHOMA SMALL BUSINESS REVOLVING LOAN FUND The Small Business Revolving Loan Program is an economic development tool administered by the City of Tullahoma. The program can provide loans for small

More information

STATE OF OREGON - OREGON YOUTH AUTHORITY EMPLOYMENT APPLICATION PERSONAL INFORMATION PREFERENCES EDUCATION COLLEGE/UNIVERSITY EDUCATION

STATE OF OREGON - OREGON YOUTH AUTHORITY EMPLOYMENT APPLICATION PERSONAL INFORMATION PREFERENCES EDUCATION COLLEGE/UNIVERSITY EDUCATION STATE OF OREGON - OREGON YOUTH AUTHORITY EMPLOYMENT APPLICATION State of Oregon Website: http://www.oregonjobs.org For instructions on where to submit your application please see the Description section

More information

IRS Form 990-N e-postcard Quick Start. Steps for filing an e-postcard

IRS Form 990-N e-postcard Quick Start. Steps for filing an e-postcard IRS Form 990-N e-postcard Quick Start Chapter 1: Steps for filing an e-postcard To file an e-postcard you must perform the following step: 1. Register with the epostcard.form990.org website as either an

More information

How To Write A Health Care Plan

How To Write A Health Care Plan USER GUIDE STEP UP PERFORMANCE MANAGEMENT SYSTEM Oklahoma State Department of Health Table of Contents Chapter 1 Getting Started... 2 Chapter 2 Overview and Public Health System Alignment... 5 Chapter

More information

Attention: Please read this entire page before filling out the application. If you do not provide what is needed, we cannot help you.

Attention: Please read this entire page before filling out the application. If you do not provide what is needed, we cannot help you. Attention: Please read this entire page before filling out the application. If you do not provide what is needed, we cannot help you. SCC CANNOT GIVE ANY IMMEDIATE HELP. Allow up to 3-4 weeks for processing

More information

ADEA Survey of Dental School Seniors, 2014 Graduating Class Tables Report

ADEA Survey of Dental School Seniors, 2014 Graduating Class Tables Report ADEA Survey of Dental School Seniors, 2014 Graduating Class Tables Report Published February 2015 Suggested Citation American Dental Education Association. (February 2015). ADEA Survey of Dental School

More information

EmployAble Pilot Study. Participant Screening and Pre-Survey

EmployAble Pilot Study. Participant Screening and Pre-Survey EmployAble Pilot Study Participant Screening and Pre-Survey EmployAble is a model Virtual Employment Orientation, Training, Resource and Support Center. It is funded by the Kessler Foundation and has been

More information

General Operating Support FY16

General Operating Support FY16 General Operating Support FY16 The Baltimore Office of Promotion and The Arts (BOPA) is the Arts Council for the City of Baltimore. A 501(c)3 nonprofit organization, it produces festivals, special events

More information

Treatment completion is an

Treatment completion is an Treatment Episode Data Set The TEDS Report Treatment Outcomes among Clients Discharged from Residential Substance Abuse Treatment: 2005 In Brief In 2005, clients discharged from shortterm were more likely

More information

Application Checklist

Application Checklist Application Checklist Listed below are the items that need to be completed for admission to Gallaudet University Adult Degree Program. Check to make sure each item has been sent to us. Your application

More information

General Membership Handbook

General Membership Handbook General Membership Handbook Revised: December 22, 2010 Table of Contents 1. Membership as a Research Scientist A. Membership Requirements B. Eligibility C. Application Process D. Fees E. Renewal Process

More information

Baker University s Professional and Graduate Programs

Baker University s Professional and Graduate Programs Baker University s Professional and Graduate Programs Application Packet Application Procedures: In order to be considered for admission to Baker University, you must complete each of the following steps:

More information

SOCIAL ENTERPRISE PROGRAMS

SOCIAL ENTERPRISE PROGRAMS SOCIAL ENTERPRISE PROGRAMS PLEASE SPECIFY SESSION DATE: APPLICATION FOR SCHOLARSHIP ADMISSION THROUGH: PLEASE INDICATE THE PROGRAM(S) FOR WHICH YOU ARE APPLYING: Governing for Nonprofit Excellence (GNE):

More information

South Dakota DOE 2013-2014 Report Card

South Dakota DOE 2013-2014 Report Card School Classification: Focus Title I Designation: Schoolwide Performance Indicators * No bar will display at the school or district level if the subgroup does not meet minimum size for reporting purposes.

More information

Move On When Ready Application Checklist

Move On When Ready Application Checklist Move On When Ready Application Checklist Student Name: SSN: High School: Counselor: Phone: Listed below are the required admissions documents for high school students to participate in the Move On When

More information

RN Refresher Program CONTINUING EDUCATION PROGRAM

RN Refresher Program CONTINUING EDUCATION PROGRAM e a s t e r n u n i v e r s i t y APPLICATION PORTFOLIO FOR CONTINUING EDUCATION ADMISSIONS CONTINUING EDUCATION PROGRAM RN Refresher Program Eastern University Department of Nursing Admissions Gatehouse

More information

Master of Arts in School Leadership

Master of Arts in School Leadership Master of Arts in School Leadership Please type or print in ink Application for Admission Last Name (Maiden) First Middle Other name(s) under which records might be filed Home Address City State Zip Home

More information

INSTITUTIONAL REPORT FOR CONTINUING ACCREDITATION: CONTINUOUS IMPROVEMENT PATHWAY. Name of Institution Dates/Year of the Onsite Visit

INSTITUTIONAL REPORT FOR CONTINUING ACCREDITATION: CONTINUOUS IMPROVEMENT PATHWAY. Name of Institution Dates/Year of the Onsite Visit INSTITUTIONAL REPORT FOR CONTINUING ACCREDITATION: CONTINUOUS IMPROVEMENT PATHWAY Name of Institution Dates/Year of the Onsite Visit Insert Name(s) of Unit Head/Author(s) NCATE IR Template for Continuing

More information

Internship Programmes At Blumenthal Performing Arts

Internship Programmes At Blumenthal Performing Arts 2015 SUMMER INTERNSHIP PROGRAM FOR COLLEGE STUDENTS A limited number of full-time summer internships at Blumenthal Performing Arts (BPA) are designed to offer arts management field experience according

More information

APPLICATION FOR FREE HOME REPAIRS DEADLINE EXTENDED!! Deadline: December 1 st

APPLICATION FOR FREE HOME REPAIRS DEADLINE EXTENDED!! Deadline: December 1 st P.O. Box 641250 Chicago, IL 60664-1250 312.201.1188 www.rebuildingtogether-chi.com APPLICATION FOR FREE HOME REPAIRS DEADLINE EXTENDED!! Deadline: December 1 st Dear Homeowner: Applications for free home

More information