GRANT APPLICATION FORM HLDF FORM 1 (Page 1)

1. To help determine if your organization and project qualify to receive grants from the Human Life and Development Fund of the Diocese of Duluth (HLDF), please complete the following questions: 2. Organizational Information Name of Organization Street Address City, State, Zip Contact Person Project Title Organizations Annual Operating Budget $ 3. The Mission Statement of the HLDF is as follows: On October 3rd, 1989, we the people of the Diocese of Duluth celebrated our Diocesan Centenary. As a thanksgiving sacrifice to God for His many blessings during those first 100 years of our existence, we have established this fund, The Human Life and Development Fund. Our purpose is twofold: First, to reach out to those among us who are needythe poor, hungry, homeless and jobless, and second, to champion the sanctity of every human life from the moment of conception through all its stages to natural death. We invite those institutions and agencies within our Diocese who share our convictions about the dignity and sanctity of human life to apply for financial grants to aid them in their work. Preference and eligibility in awarding grants will be determined by the Human Life and Development Fund Committee. 4. Does your organization agree in full with the Catholic teachings on the dignity and sanctity of all human life and on the purpose of the HLDF as it is expressed in the above Mission Statement (yes or no)? If no, please explain in what areas you disagree and why. Phone Title Amount Requested $

GRANT APPLICATION FORM HLDF FORM 1 (Page 2)

5. Does your organization currently fund projects which are not in agreement with the purpose of the HLDF in whole or in part? Has your organization done so in the past?

6. On a separate sheet of paper, please give some background on your organization including its history, the people and area it serves, the number of programs it has and how they operate as well as any other information which may be relevant. In addition, please describe how your organization reflects the HLDF Mission Statement. Specifically, how does your organization reach out to the needy and/or champion the sanctity of human life from the moment of conception to natural death? 7. Has your organization applied for grants from the HLDF in the past? please list the amount of the grant(s) and when they were awarded: $ $ $ Date Date Date If yes,

8. If you have applied for a grant in the past, copies of your Articles of Incorporation, Federal Tax Exemption Ruling (IRS 501 (C) 3 letter) and Employer ID Number, and Mission Statement are kept on file at the HLDF office. If any of the above have changed since your last grant application, please include an updated copy of the document(s) in question. 9. If you have not applied for a grant in the past, please include one copy of the following: a) Articles of Incorporation registered in the State of Minnesota b) Federal Tax Exemption Ruling (IRS (C) 3 letter) and Employer ID Number c) Mission Statement

GRANT APPLICATION FORM HLDF FORM 1 (Page 3)

10. All applicants must include: a) Their most recent audit report if available, or their most recent year-end financial statement b) A current list of their Board of Directors

11. Please give a complete description of the proposed project including: a) The need for the program b) The number of and intended beneficiaries c) The anticipated results d) The plan of action (specific activities or methods to be used to reach the projects goals and objectives) and a time line e) The staffing planinclude the names and qualifications of the individual(s) responsible for implementing the project f) A list of organizations that will be cooperating or coordinating in the carrying out of the project (include letters of support if available) g) A plan to evaluate the project h) A plan for funding the project after the grant period i) The current annual agency operating budget j) A complete itemized project budget which includes --the specific amount requested from the HLDF --other expected income including a list of sources and dollar amounts committed or pending --expected expenses --in-kind services which will be donated to the program

GRANT APPLICATION FORM HLDF FORM 1 (Page 4)

12. Keep the grant application concise (approximately three pages, not including enclosures) 13. Send one (1) original and seven (7) copies of the grant application to: Human Life and Development Fund Diocese of Duluth 2830 East Fourth Street Duluth, MN 55812 14. Grant applications prepared for submission to other funders will be accepted providing the above information is included. The HLDF Committee is sensitive to varying levels of experience in writing grant applications. 15. Additional comments you would like to make.

16. Signature and Title

Date

************
Please note that the award of a grant does not mean organizations can expect or count on future funding from the HLDF. Organizations should therefore not plan to include grants from the HLDF in their annual budgets. Preference will be given to organizations just getting started or for new projects rather than for annual maintenance of established organizations. In most cases, organizations should not expect funding to extend beyond three consecutive years.

Mail this Grant Application Form to: Attn: Grace Romanek, Diocese of Duluth, Human Life and Development Fund, 2830 East 4th Street, Duluth, MN 55812.
(12/09revised-computer)