2021 Leadership Grant Application

Please Note: This grant application requests an application narrative and supporting documents.

Instructions:

1. Please visit our website to review funding guidelines and resources that informed development of our Just For Kids Theory of Change. In particular, please read “The Dawn of System Leadership” by Peter Senge, Hal Hamilton, and John Kania.

2. Please fill in all spaces. Please do not include materials other than those specifically requested.

3. Please submit all application materials electronically by 11:59pm CT on July 30, 2021.

LEADERSHIP GRANT APPLICATION FORMAT AND REQUIREMENTS

Application Narrative - Leadership Grants are available to Deaconess Impact Partners (DIP). Applicants should submit a narrative of no more than two (2), double-spaced pages identifying current organizational capacity building priorities. Please also describe how your chief executive plans to engage in advocacy or policy change efforts using the outline below. In the narrative, please address each item below:

Capacity-Building Sustainability
- How has your organization sustained a capacity-building culture (i.e. strategic planning, board development, succession planning, financial modeling, equity and inclusion practices, etc.) since your engagement as an Impact Partner?
- What are your current capacity-building priorities?
- What systems change efforts are the chief executive involved in or seeking to engage in the next twelve months?
Diversity, Equity and Inclusion
- Describe the specific geographic areas and populations (e.g. counties, municipalities or neighborhoods AND ages, race/ethnicity, income level, population size, etc.) that will be impacted by, and benefit from, this funding request.
- Please provide the racial/ethnic and gender demographics of your organization’s staff and board.
- How do your organization’s efforts serve and/or impact different racial/ethnic groups?
- How are the racial/ethnic groups most affected by your efforts represented in your organization’s work?
Implementation and Evaluation
- How will the proposed capacity building effort be implemented? Include a brief timeline outlining anticipated activities.
- Deaconess Impact Partners who receive Leadership Grants will be expected to participate in the annual executive directors’ retreat, a capacity assessment (with results available to you for planning), and Deaconess’ program evaluation.
Financial and Supporting Documents

Please include the following supporting documents with your application as outlined below:
- A one-page project budget that outlines how requested funds (up to $15,000) will be utilized.
- Organization’s last completed fiscal year budget (including actuals)
- Board-approved, current fiscal year budget (please note start and end dates for your fiscal year)
- Most recent audited financial statement
- Copy of most recent strategic plan
- List of current members of board of directors, including professional affiliations
For more information, please contact: Michael Shultz, Program Assistant at michaels@deaconess.org or 314-436-8001

Applicant Legal Name (as shown on IRS Letter of Determination) *

Doing Business As (if different from legal name)

Organization's Website *

EIN # *

Address *

City *

State *

Zip Code *

Telephone # *

Fax #

Impact Partnership Award Round *

2005-2009

2008-2012

2012-2016

Executive Director (or top executive) *

Executive Director's phone number *

Executive Director's email address *

Main contact person for this Leadership Grant proposal: *

Contact person's phone number *

Contact person's email address: *

Board Chair *

Board Chair's phone number *

Board Chair's email address *

Date of last CCAT *

Date of last Strategic Plan *

Project Time Period *

Amount Requested *

I am requesting one or two years of support *

One year

Two years

Total Project Budget for this period *

Current Annual Organizational Budget *

Alignment Checklist - Below please check all areas that apply to assess alignment with the Just for Kids Theory of Change

The chief executive’s leadership will influence the following Capacities for positive policy change: *

Youth and child advocates equipped and positioned to move system

Increased citizen contact with policymakers

Child service providers oriented to advocacy

Community organizers focused on children

Strengthened alliances for child well-being policy

Churches engaged in child advocacy

Sustainable, better capitalized community development financial institutions

The chief executive’s leadership will affect changes in the following public Arenas: *

The chief executive’s leadership will affect changes in the following public Arenas:

Policymakers aware of innovative solutions

Available, affordable and accessible accredited child care

Restorative justice practices in schools

Equitable contacts and outcomes for youth in criminal justice and child welfare systems

Accessible, affordable high-quality medical, mental and oral health homes

Family-supporting living wages

Accessible, effective asset building supports and services

The chief executive’s leadership ultimately seeks the following Results *

Physical, social, emotional and cognitive kindergarten readiness

Reconciliation of disparate infant mortality rates

Youth receive just treatment under the law

Family economic stability attainable within one generation

Policy shifts aligned with Deaconess Foundation policy priorities

Community affirmation of a child’s right to well-being and responsibility to create circumstances for each child to flourish

Application Narrative File Upload

Please upload the application narrative of no more than two (2), double-spaced pages. *

Financial and Supporting Documents File Upload

Please upload the itemized one-page project budget and a budget narrative (one-page or less). *

Please upload the organization's last completed fiscal year budget AND board-approved, current fiscal year budget (include actuals and note start and end dates for your fiscal year). *

Please upload the most recent audited financial statement. *

Please upload a copy of the most recent strategic plan. *

Please upload a list of current members of the board of directors, including professional affiliations. *

Fiscal Agent

If applying with a fiscal agent, please upload the IRS Determination Letter for the fiscal agent and a copy of a signed agreement letter between the applicant and the fiscal agent.

Agreement: I certify to the best of my knowledge, that all information included in this proposal is correct. The tax exempt status of this organization, or its fiscal agent, is still in effect. If a grant is awarded to this organization, then the proceeds of that grant will not be distributed or used to benefit any organization or individual supporting or engaged in applicable anti-terrorist financing and asset control laws, statutes, and executive orders.

In the space below, please use your cursor to sign your name, or if you have a touch screen, please sign with your finger on your screen.

Signature, Executive Director (or authorizing official on behalf of the organization) *

clear

Date *