Healing Illinois Grant Resources

Organization Information

• 1. Name of organization
• 2. Mission/Vision

• 3. Year Founded
• 4. Organization EIN
• 5. IRS Status
• 6. GATA Certified
• 7. Primary Contact Name
• 8. Primary Contact Email
• 9. Primary Contact Phone
• 10. Primary Address
• 11. Executive Director/CEO Name
• 12. Executive Director/CEO Email
• 13. Executive Director/CEO/President - Ethnic and Racial Identity

Organizational Diversity

• 14. Staff Composition | What percent of your staff is volunteer (unpaid)? Drop-down options: None, Less than 10%, 10-20%, 21-40%, 41-50%, 51% or more.
• 15. FTE - Staff - Total | What percent of your staff is FTE (full time equivalent)? Drop-down options: None, Less than 10%, 10-20%, 21-40%, 41-50%, 51% or more.
• 16. FTE - Staff - Black, Indigenous, and People of Color (BIPOC) | Enter the number of BIPOC individuals serving as FTE staff members in the organization. Do not include volunteers.
• 17. Leadership | Is the senior leadership and board directed, managed, and/or led by a majority of BIPOC individuals (51% or more).
• 18. Board Size Total

Application Summary

• 19. Project Name (500 character limit)
• 20. Project Summary (1500 character limit):
• 21. What funding priority will your project focus on? Drop-down menu listing 4 funding priorities
• 22. Please select which region area your organization will primarily serve, Region 1, Region 2, Region 3, Region 4, Region 5.
• 23. Is this a collaborative project? [Yes or No]
• 24. Please list any organizations you are partnering with to implement your proposed project. (3000 character limit)
• 25. Total Project Budget
• 26. Grant Request Amount
• 27. Geographic Area served by project
• 28. Estimated number of participants
• 29. Estimated number of activities associated with the project
• 30. Target population | Ethnic and Racial Groups Served
• 31. Tell us about your project idea. Who? What? When? Where? Why? (3000 character limit)
• 32. How do you know your organization is ready for this work and has the capacity to do it? (3000 character limit)
• 33. What problem/issue/community need are you addressing? (2000 character limit)
• 34. Describe associated short outcomes of the project. (2000 character limit)
• 35. How will you measure impact? (2000 character limit)

Media

• 36. Please submit a high resolution image of your organization's logo. This will be used on our website and social media platforms if your application is approved.
• Logo upload
• Website address
• Social Media information for organization

Financial Information

• 37. Fiscal Year End Date:
• 38. Annual Operating Budget:
• 39. Most Recent Financial Statements
• 40. Project Budget (Upload as attachment)