Please provide your proposed total budget for the current fiscal year and your total budget for the last fiscal year. If you are part of a national organization, provide this information for both your national and local (Chicago) operations.

Please note the organization’s fiscal year and include total local (and national, if relevant) revenue for the last two years, as well as a percentage breakdown by source for the latest fiscal year. Please provide a breakdown according to (a) government, (b) corporate, individual, private, and foundation, (c) special events, (d) tuition and fees, and (e) other.

Paid full-time staff, number of paid part-time staff, and number of volunteers.

Describe any business affiliations with national or regional organizations that oversee or provide significant support to the local program.

If the purpose of the award is to fund a segment within an organization, please elaborate and explain the institutional relationship.

Identify your organization's key leaders, including staff and board members, and briefly describe their roles, experience, how long they have held such positions, and any recent changes in key personnel.

Describe briefly how services are provided and what differentiates your work from other similar organizations.

Describe the program’s impact and how it is measured. Indicate if any outside independent evaluations have been completed to determine effect.

Describe any immediate or long term growth plans and how they will be achieved.

I verify that I have the authority to submit this application on behalf of the named organization and that, to the best of my knowledge, everything contained in the application is true as of the date submitted.