Advocacy & Programs → Grant Submission Lifting up the voices in the LGBTQ+ community, near and far.

Online Grant Submission Form

Please fully read and review the grant program guidelines prior to completing the grant submission form.

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Organization Overview

Organization name: *

Street Address: *

State/Province: *

City: *

Zip/Postal Code: *

Organization phone: *

Organization website: *

Organization EIN: *

Upload proof of 501(c)(3) status i.e., an IRS determination letter verifying certification as a tax-exempt 501(c)(3) corporation or other acceptable documentation of charitable tax-exempt status: *

Grant submitted by (First and Last Name and Title): *

Submitter email address: *

Submitter phone: *

Preferred method of contact: *

EmailPhone

If other, please list:

Organization mission statement and an explanation of how it aligns with HCAI’s mission (detailed in grant program guidelines): *

Provide a brief history about the organization including years of operation and overview of three key projects or programs: *

List of organization’s Board of Directors with brief bios: *

List of key staff associated with the project/program. Include brief bios: *

Current operating budget, additional financial documents to support your request and a copy of your most recent audited statement: *

Who are the organization’s main supporters and/or funders? How much funding does the organization regularly receive?: *

Has your organization previously received funding from HCAI? If so, briefly describe the reason for the donation(s), the amount(s) received and date(s) of funding: *

Grant Request Summary

Please provide an overview of your proposal detailing key reasons why your organization should be selected for this funding opportunity: *

Grant Submission Details

Budget: *Please include amount being requested, itemized budget for the project/program and contributions from other funding sources.

Program/Project description: *Provide a detailed description of the program/project for which the organization seeks funding including objectives, purpose, need, design and strategy and how the grant, if provided, would advance these objectives.

Target audience(s): *Summarize the target audiences that will be impacted by this project/program including (where possible) number of people that will be served and geographic location of audience(s). Be sure to include details that indicate how members of the LGBTQ+ community will be assisted and/or supported through this effort.

Evaluation and results measurement: *Provide specific details about how the impact of the project/program will be evaluated and measured. For example, an increase of XX% in participation/attendance/individuals served.

Timeline: *Provide a detailed overview of the proposed timeline including planning, implementation, and results measurement.

Partners: *Please list any partners or potential partners and their role with your organization and/or this program/project.

Conflicts or potential conflicts: *If applicable, please list and address any potential or actual conflicts with your organization’s mission and the activities of any officers and the HCAI mission. If none, please state the same.

Supplemental Information

Upload additional images, and/or documentation that supplements/supports the organization’s funding request. Any videos should be included via a link in the appropriate text field(s) below.

Item 1 (if document/image):

Item 1 (if external link):

Item 2 (if document/image):

Item 2 (if external link):

Item 3 (if document/image):

Item 3 (if external link):

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