Primary South Vancouver Island - Before completing this proposal, please review the Proposal Funding section on our website: www.utdway.ca All applications must include: (1) Completed grant proposal form and (2) Names and contact details of 2 references who may be asked to speak to the organizations capacity to implement the project/initiative and other pertinent information specific to the application. Please Note: Additional supporting documentation may be requested including, but not limited to: annual reports, financial statements and partner letter. Section A: Applicant Information Date of submission: day of 201. Program/Project Title: Organization Name: Charitable Registration #: Organization Website: Mailing Address: Contact Name: Title: Phone #: Email: Page 1 of 8
Have you previously applied to Success By 6 for funds? Yes No If Yes: Project title: Year(s) funded: Amount funded: $ Interim and/or final reports: Section B: Background 1. What is the organization s mission statement? 2. Please provide a brief description of the program or project for which you are requesting funding (limit 100-200 words). This may be used on the Success By 6 website for informational purposes. 2.1 Goals (purpose) Page 2 of 8
2.2 Anticipated Outcomes Please indicate which outcomes will be achieved through the initiative, and strategies that will help achieve the outcomes Children/ Family Check the outcome(s) that this program or project aligns with. Increased social/emotional skills Increased supports for children Increased health/wellbeing Enhanced parenting capacity Increased language/communication Other: Strategies to achieve these outcomes: Community: Check the outcome(s) that this program or project aligns with. Increased awareness of early childhood development and the needs of families with young children Increased awareness of needs of children with diverse needs (socio-economic, access barriers, special needs) Increased collaboration/integration between service providers within the community Enhanced relationship with the municipality, region, community in relation to ECD Increased knowledge about the needs of families and children in the community Other: Strategies to achieve these outcomes: Page 3 of 8
Aboriginal: Check the outcome(s) that this program or project aligns with. Increased support for children who are Aboriginal/Metis/First Nations Enhanced collaboration/integration between service providers Enhanced relationship with the community/band Greater awareness of Early Child Development within the community Other: Strategies to achieve these outcomes: Professionals: Check the outcome(s) that this program or project aligns with. Increased skills, knowledge, and changes to practice Increased collaboration/integration at the frontline/program-level Other: Strategies to achieve these outcomes: 2.3 Anticipated number(s) of children/families participating? (Explain how you determined this) 2.4 How will participation barriers be addressed? Page 4 of 8
2.5 Project timeline 2.6 Population Children 0-6 Aboriginal children 0-6 Parents Young parents Refugee families Aboriginal parents Low income Immigrant families Other (please specify) 2.7 Is this a universal or a targeted program? Universal Targeted 2.8 If targeted, why is it targeted, and what barriers does this specific population face in accessing other programs? Section C: Partnerships/Collaboration 1. List all partners (funding, in-kind, other) to be involved in this project and their roles/responsibilities. 2. If applicable, please explain why this project will not be delivered in partnership with other organizations: 3. Does your project align with: 3.1. Funding priorities outlined in the Success By 6, United Way of South Eastern Alberta Funding Framework. Page 5 of 8
Please explain Section D: Evaluation 1. How does the research and/or evidence-based information support the need for this program? 2. What methods will be used to evaluate the project and outcomes? (i.e. satisfaction survey, client feedback, anecdotal testimonials, photo-voice, pedagogical narration, Success By 6 Stakeholder and/or parent survey). You will be required to provide results in the interim and final report. Section E: Sustainability 1. What other strategies are you considering to secure funding beyond Success by 2. What would the impact be if only a portion of the funding is available? Page 6 of 8
3. If the project is ongoing, how will you do this beyond the funds from Success By 6? Section F: Budget and Amount Requested 1. Provide a budget for the project in the table below: Estimated program/project expenses Detailed item description Resources from other funders In-Kind Amount requested from SBy6 Total cost Human Resources (salary, wages, benefits, honoraria, contractors, volunteers) Materials and supplies Evaluation Promotion and Marketing Other Administrative Total expenses Page 7 of 8
Primary Contact Secondary Contact Please provide the name and contact information of two (2) references who can speak to this project and the capacity of the organization Name: Name: Title: Title: Organization: Organization: Phone #: Phone #: Email: Email: I affirm that the information in this application is true and complete. To ensure that your Board of Directors is aware that you are applying for this grant, please have a member of your Board sign below Executive Director Signature Date Board Member Position Page 8 of 8