2021 Mission-Related Investment 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.

2. Please answer all questions, and do not include any materials other than those specifically requested.

3. Please submit all application materials by 11:59pm CT on October 15, 2021

4. If you have any questions or would like assistance, please contact Michael Shultz at michaels@deaconess.org

5. If you need to save your work, use the "Save Progress" button at the bottom of the form to create an account. If you have created an account and would like to sign in to review your saved work, use the "Log In" button below.

6. When you've completed the form, use the "Submit" button at the bottom of this page.

7. Eligibility requirement: must have a tax exempt designation (i.e 501(c)3)) to be eligible to apply.

8. Click here to view the 2021 Mission Related Investment Term Sheet.

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Use an account to return to saved work.

MISSION-RELATED INVESTMENT APPLICATION FORMAT AND REQUIREMENTS

I. Application Narrative

Please submit a narrative document describing how the requested capital investment will expand your organization’s capacity while also strengthening the community in alignment with Deaconess policy priorities to advance child well-being in the St. Louis metropolitan region. Proposals that do not follow these guidelines will not be considered for investment.

In the narrative of no more than four (4) double-spaced pages, please describe your capital request by addressing the following:

Organizational Excellence

How will the requested capital investment expand your organization’s capacity or further your organizational goals?
What strategic partners or stakeholders are you engaging with on this effort? Include any ways that your organization strives to incorporate the perspective of the communities you serve.

Impact and Alignment

How will the requested capital investment provide social returns by strengthening the community in alignment with one or more of the Deaconess policy priorities?
How will you measure financial and social performance for this investment?

Racial equity, diversity and inclusion

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? Children/youth?
How are the racial/ethnic groups most affected by your efforts represented in your organization’s work?

Financial Strength and Sustainability

Describe the requested investment, including your business plan and timeline. Please include any risks and plans for risk mitigation.
What is your organization’s track record of, and qualifications to manage and repay a loan?
Describe your organization’s capacity to repay the loan including expected revenues, operating reserves, or other financial resources to be used for repayment.
What potential financing or other resources will be attracted to support your effort?

II. Financial and Supporting Documents

Please include the following supporting documents with your application:

Itemized FY 2021 Operating Budget (with actual expenses and revenues)
Last three years’ audited financial statements or IRS Form 990s
IRS Determination Letter
One Paragraph Biographies for Each Senior Staff Member
List of Current Board Members with their Professional Affiliations
Supplemental materials demonstrating organizational and financial strength, readiness for borrowing and repayment of the investment, and efforts in alignment with Deaconess policy priorities (i.e. theory of change, business model, strategic plan, articles, etc.)

Organizational Website *

EIN # *

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

Doing Business As (if different from legal name)

Tax Exempt Status/IRS Designation *

Address *

City *

State *

Zip Code *

Phone # *

Fax #

Executive Director (or Top Executive) *

Executive Director's Phone # *

Executive Director's Email Address *

Main Contact(s) for this Specific Project *

Main Contact's Phone # *

Main Contact's Email Address *

Deaconess Policy Priority Advanced *

Early Childhood Education

Justice & Equity for Youth

Comprehensive Healthcare

Family Economic Mobility

Project Time Period *

Project/Initiative Name *

Current Annual Organizational Budget *

Date funds are needed: *

Amount Requested *

Proposal Summary - In 150 words or less, provide a summary of your capital request defining how your effort will advance child well-being and the impact you expect to achieve with the requested investment. *

0/100 words

Geographic Area(s) and Population(s) Impacted: Describe the specific geographic areas and populations (e.g. regions, counties, municipalities, cities, communities, localities or neighborhoods AND ages, race/ethnicity, income level, population size, etc.) that will be impacted by, and benefit from, this capital request *

Application Narrative File Upload

Please upload the application narrative of no more than four (4), double-spaced pages. *

Financial and Supporting Documents File Upload

Please upload the following supporting documents:

Itemized FY 2021 Operating Budget (with actual expenses and revenues)
Last three years’ audited financial statements or IRS Form 990s
IRS Determination Letter
One Paragraph Biographies for Each Senior Staff Member
List of Current Board Members with their Professional Affiliations
Supplemental materials demonstrating organizational and financial strength, readiness for borrowing and repayment of the investment, and efforts in alignment with Deaconess policy priorities (i.e. theory of change, business model, strategic plan, articles, etc.)

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 *

Reserved Rights

Deaconess Foundation reserves the right to: accept or reject any or all applications submitted; request additional information from any or all respondents; and contact respondents to ensure full understanding of and responsiveness to the solicitation requirements.