Connecticut Health Foundation

Changing Systems, Improving Lives

The Connecticut Health Foundation (CT Health) awards grants to organizations and institutions that respond to its strategic objectives and directly impact Connecticut residents.

CT Health sometimes considers proposals from organizations needing less than $25,000 in funds through the President’s Discretionary Grant Award program. These initiatives should support at least one of our funding priority areas and/or strategic objectives (please see our strategic plan under “About Us”

The process for submitting a President’s Discretionary Grant Award application is different from other grant application processes at CT Health. There is only one step: submission of your proposal which includes the President’s Discretionary Grant Award Cover Sheet, Proposal Narrative, and Organizational Diversity Chart.

President’s Discretionary Grant Award applications are accepted throughout the year and have no application deadlines. Funding decisions are made by the President & CEO in conjunction with the Board of Directors, Chair, or Program Committee Chair.

How to fill out this form using your computer:
  1. Save this file to your computer using the naming convention “your_name-2016_pres_disc.doc”.
  1. Complete all fields by typing your responses into the blank fields or inserting the letter “X” in the appropriate left column space for multiple-choice questions.
  2. Proposals must be filled out using 11-pt, Arial font and have 1” margins. They are not to exceed the indicated page limits.
  1. When you are finished, save the application as either a MS Word or PDF document.
  2. Scan your IRS Letter of Determination of 501 (c)(3) status, or documentation from your fiscal agent.
  3. Please email the application and IRS Letter of Determination to .

OfficialName of Organization
Address
City, State, Zip Code
Name of Project Director
Email Address
Telephone
Fax
Website Address
PLEASE CHECK ONE: / 501 (c)(3) / Public Entity / Other
Project Title
Amount Requested

Is there an organization acting as a fiscal agent for this project?

Yes
No

If yes, please indicate below:

Name of Fiscal Agent / Telephone
Name of Executive Director / Telephone
Email Address / Fax
Telephone
Fax

In this section, applicants must explain the relevance of the project or idea in relation to at least one of CT Health’s funding priority areas and/or strategic objectives.

[Not to exceed 5 pages]

1.What need(s) are you looking to address? Please provide relevant data or research to make your case.

2.What are your goals and objectives for this request?

3.What are your expected outcomes? Please explain the scope and scale of the impact you expect to make on the issue you are addressing.

4.What strategies do you plan to implement to achieve the proposed goals, objectives, and outcomes?

5.Please provide a project plan by bulleting out the key benchmarks and deliverables by quarter for the proposed grant period.

6.Please indicate the total funds needed to implement the project and the amount requested from CT Health. If applicable, indicate other sources of funding – both committed and pending.

Organizational Diversity Chart
Show total number and percentage for each
(i.e. 25/10%) / Board Members / Staff / Members
(if applicable) / People Served
(if direct services provided)
Total Number
Diversity by Race/Ethnicity
African American/Black
American Indian or Alaska Native
Asian
Hispanic/Latina/Latino
Native Hawaiian or other Pacific Islander
White
Other:

How does the organization’s diversity reflect the community and/or the geographic area you work in?

Please begin your text here:

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