NEIGHBORHOOD IMPLEMENTATION GRANT APPLICATION
Preview Form
This is an example of the application questions with which you will be presented. It is recommended that you compose the answers to the paragraph questions in a word processing program and then cut and paste that text into the online application.
Organization Information
*Legal Name
(Text; 100 character maximum)
Instructions:
  • What is the legal name of your organization?
  • AKA Name
    (Text; 100 character maximum)
    Instructions:
  • If your organization is known by another name please enter the name here.
  • *Address
    (Text; 100 character maximum)
    Instructions:
  • *City
    (Text; 50 character maximum)
    Instructions:
  • *State
    (Single-Select List)
  • (Not Applicable)
  • Alabama
  • Alaska
  • American Samoa
  • Arizona
  • Arkansas
  • Armed Forces Africa/Canada/Europe/Middle East
  • Armed Forces Americas (except Canada)
  • Armed Forces Pacific
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Federated States of Micronesia
  • Florida
  • Georgia
  • Guam
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Marshall Islands
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Northern Mariana Islands
  • Ohio
  • Oklahoma
  • Oregon
  • Palau
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
  • Instructions:
  • *ZIP Code
    (Text; 20 character maximum)
    Instructions:
  • *Telephone
    (Text; 30 character maximum)
    Instructions:
  • Fax
    (Text; 30 character maximum)
    Instructions:
  • Website Address
    (Text; 100 character maximum)
    Instructions:
  • *Year Organization was Established
    (Number; 4 digit maximum)
    Instructions:
  • Executive Director
    (Yes/No)
    Instructions:
  • Does the organization have an executive director? If no Executive Director, enter the name of the development director or lead officer below.
  • Executive Director/Lead Officer
    (Text; 255 character maximum)
    Instructions:
  • Enter the name of your organization's executive director or leader.
  • *Mission Statement
    (Paragraph; 500 character maximum)
    Instructions:
  • Provide a very brief mission statement for your organization.
  • *Organization Type
    (Single-Select List)
  • Arts & Culture
  • ----Arts & Culture - Arts Council/United Fund
  • ----Arts & Culture - Museums
  • ----Arts & Culture - Other
  • Civic Organization
  • ------Civic - Citizen Education
  • ------Civic - Civic Leadership
  • ------Civic - Community Beautification
  • ------Civic - Cultural Diversity
  • ------Civic - Humane Societies
  • ------Civic - Other
  • ----Civic - Libraries
  • Community Development
  • ----Community Development - Other
  • ----Community Development-Economic Development
  • Education
  • ----Education - Higher Ed - HBCU
  • ----Education - Higher Education
  • ----Education - Other
  • ----Education - PreK through 12
  • Environment
  • ------Environment - Global Issues
  • ------Environment - Preservation of endangered species
  • ------Environment - Preservation of natural resources
  • Health & Human Services
  • ----HHS - Local United Way Office
  • ----HHS - Other
  • ----HHS - United Way Agency
  • Instructions:
  • Please select the organization type that best describes your organization. You must select a lowest level.
  • Contact Information
    *Salutation
    (Text; 100 character maximum)
    Instructions:
  • Enter the contact person's salutation (Mr., Ms., Mrs., Dr., etc.)
  • *First Name
    (Text; 40 character maximum)
    Instructions:
  • *Last Name
    (Text; 40 character maximum)
    Instructions:
  • *Title
    (Text; 50 character maximum)
    Instructions:
  • *Address
    (Text; 100 character maximum)
    Instructions:
  • *City
    (Text; 50 character maximum)
    Instructions:
  • *State
    (Single-Select List)
  • (Not Applicable)
  • Alabama
  • Alaska
  • American Samoa
  • Arizona
  • Arkansas
  • Armed Forces Africa/Canada/Europe/Middle East
  • Armed Forces Americas (except Canada)
  • Armed Forces Pacific
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Federated States of Micronesia
  • Florida
  • Georgia
  • Guam
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Marshall Islands
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Northern Mariana Islands
  • Ohio
  • Oklahoma
  • Oregon
  • Palau
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
  • Instructions:
  • *ZIP Code
    (Text; 20 character maximum)
    Instructions:
  • *Telephone
    (Text; 30 character maximum)
    Instructions:
  • Fax
    (Text; 30 character maximum)
    Instructions:
  • *E-mail Address
    (Text; 100 character maximum)
    Instructions:
  • *Contact Type
    (Single-Select List)
  • Board Member/Trustee
  • Campaign Contact
  • Employee
  • General
  • Primary Contact
  • TTI Contact
  • Western New
  • Instructions:
  • Select the contact type which best describes this contact.
  • Organizational Details
    *Organization Background
    (Paragraph; 2000 character maximum)
    Instructions:
  • Organization's background (brief highlights)
  • *Operating Support & Revenue
    (Currency; 20 character maximum)
    Instructions:
  • Total Operating Support & Revenue at the end of the most recent fiscal year.
  • *Operating Expenses
    (Currency; 20 character maximum)
    Instructions:
  • Total Operating Expenses at the end of the most recent fiscal year
  • *Financial Health
    (Single-Select List)
  • Exceptional
  • Strong
  • Acceptable
  • Weak
  • Insolvent
  • Instructions:
  • Check which best describes the financial health of your organization.
  • *Financial Health Detail
    (Paragraph; 2000 character maximum)
    Instructions:
  • Provide a more detailed description explaining the financial health of your organization based on the category selected in the previous question.
  • FT Employees
    (Number; 15 digit maximum)
    Instructions:
  • Number of Full-Time Employees
  • PT Employees
    (Number; 15 digit maximum)
    Instructions:
  • Number of Part-Time Employees
  • Project Overview
    *Requested Grant Amount
    (Currency; 20 character maximum)
    Instructions:
  • (In U.S. dollars)
  • *Requested Time Frame
    (Number; 15 digit maximum)
    Instructions:
  • Requested length of grant period (months). Foundation development grants are funded over 36-60 months.
  • *Project Title
    (Text; 255 character maximum)
    Instructions:
  • (255 character limit)
  • *Project Description (short)
    (Paragraph; 2000 character maximum)
    Instructions:
  • Short Project Description (one paragraph).
  • *Use of Funds
    (Paragraph; 2000 character maximum)
    Instructions:
  • Specific use for requested grant funds

    Please Note: The Foundation only funds programatic expenses and does not support capital or general operating costs.
  • *Project Mission Analysis
    (Paragraph; 2000 character maximum)
    Instructions:
  • Please describe how your project fits the Foundation's mission. What is its strategic relevance to the Foundation's mission and guiding principles?
  • *Project Purpose
    (Long Paragraph)
    Instructions:
  • Describe the overarching purpose of the project and the areas or factors of the neighborhood that will be different at the end of the grant period.
  • *Current Progress
    (Long Paragraph)
    Instructions:
  • Progress to Date
  • *Other Resources
    (Paragraph; 2000 character maximum)
    Instructions:
  • List Other Funding Sources (Public and Private) and amounts for the project (detail pending or committed).
  • *Project Partners
    (Paragraph; 2000 character maximum)
    Instructions:
  • Has the organization developed partnerships with other organizations/agencies/resident groups for this project? If not, please explain. If yes, please list the relationships and describe how the organization is managing these partnerships.
  • *Community Needs
    (Long Paragraph)
    Instructions:
  • Define and document the community needs that the proposed project will address and how it will address them.
  • Overall Neighborhood Plan Implementation Budget
    (No input required)
    Instructions:
  • *Capital Expenses
    (Currency; 20 character maximum)
    Instructions:
  • Please outline the budgeted capital and non-capital expenses necessary to implement the Overall Neighborhood Plan.
  • *Non-Capital Expenses
    (Currency; 20 character maximum)
    Instructions:
  • *Overall Neighborhood Plan Implementation Budget
    (Currency; 20 character maximum)
    Instructions:
  • Total Neighborhood Plan Implementation Budget (Capital + Non-Capital Expenses)
  • Project Outcomes
    Please provide the key projected measurable outcomes to result from this project
    *Community Impact
    (Paragraph; 2000 character maximum)
    Instructions:
  • Briefly explain the overall, ultimate impact the project will have on the community.
  • *Short Term Outcomes
    (Paragraph; 2000 character maximum)
    Instructions:
  • Short Term Outcomes (1 Year).
  • *Intermediate Term Outcomes
    (Paragraph; 2000 character maximum)
    Instructions:
  • Intermediate Term Outcomes (2 - 3 Years).
  • *Long Term Outcomes
    (Paragraph; 2000 character maximum)
    Instructions:
  • Long Term Outcomes (3 - 5 Years and beyond).

  • (No input required)
    Instructions:

  • (No input required)
    Instructions:
  • Neighborhood Overview
    *Target Neighborhood
    (Text; 255 character maximum)
    Instructions:
  • Name of target neighborhood.
  • *Neighborhood Size
    (Number; 15 digit maximum)
    Instructions:
  • How many square miles is the target neighborhood?
  • *Neighborhood City/Municipality
    (Text; 255 character maximum)
    Instructions:
  • In what city or municipality does the target neighborhood reside?
  • *Neighborhood County
    (Text; 255 character maximum)
    Instructions:
  • In what county does the target neighborhood reside?
  • *Neighborhood Borders
    (Paragraph; 2000 character maximum)
    Instructions:
  • What are the streets that border the target neighborhood?
  • *Neighborhood Census Tracts
    (Paragraph; 2000 character maximum)
    Instructions:
  • What are the primary census tracts for the target neighborhood?
  • *Neighborhood Population Size
    (Number; 15 digit maximum)
    Instructions:
  • How many people live within the target neighborhood?
  • *Neighborhood Setting
    (Single-Select List)
  • Large Urban
  • Small Urban
  • Inner Ring Suburb
  • Outer-Ring Suburb
  • Rural
  • Instructions:
  • Select the setting which best describes the neighborhood.
  • *Neighborhood Age Distribution
    (Percentage List)
  • Ages 18-65
  • Seniors (>65)
  • Youth (<18)
  • Instructions:
  • What is the neighborhood's age distribution?

    Enter whole numbers only. All values must total 100 percent.
  • *Neighborhood Race
    (Percentage List)
  • Asian
  • Black or African American
  • White
  • Other
  • Instructions:
  • What is the racial demographic of the neighborhood residents?

    Enter whole numbers only. All values must total 100 percent.
  • *Neighborhood Ethnicity
    (Percentage List)
  • Hispanic or Latino
  • Not Hispanic nor Latino
  • Instructions:
  • What is the neighborhood's Ethnicity?

    Enter whole numbers only. All values must total 100 percent.
  • *Neighborhood Education
    (Percentage List)
  • College
  • Some College
  • High School
  • Less than High School
  • Instructions:
  • What are the education levels of the residents?

    Enter whole numbers only. Percentages must total 100%.
  • *Neighborhood Poverty
    (Number; 15 digit maximum)
    Instructions:
  • What percent of residents live in poverty?
  • *Neighborhood Median Income
    (Currency; 20 character maximum)
    Instructions:
  • What is the median household income for the neighborhood?
  • *City Median Income
    (Currency; 20 character maximum)
    Instructions:
  • What is the median household income for the city?
  • *County Median Income
    (Currency; 20 character maximum)
    Instructions:
  • What is the median household income for the county?
  • *State Median Income
    (Currency; 20 character maximum)
    Instructions:
  • What is the median household income for the state?
  • *Neighborhood Unemployment
    (Number; 15 digit maximum)
    Instructions:
  • What is the neighborhood's average unemployment rate?
  • *City Unemployment
    (Number; 15 digit maximum)
    Instructions:
  • What is the city's average unemployment rate?
  • *County Unemployment
    (Number; 15 digit maximum)
    Instructions:
  • What is the county's average unemployment rate?
  • *State Unemployment
    (Number; 15 digit maximum)
    Instructions:
  • What is the state's average unemployment rate?
  • *Neighborhood Housing Vacancy Rate
    (Number; 15 digit maximum)
    Instructions:
  • What is the neighborhood's housing vacancy rate?
  • *Neighborhood Owner Occupancy Rate
    (Number; 15 digit maximum)
    Instructions:
  • What is the neighborhood's owner occupancy rate?
  • *Neighborhood Median Housing Price
    (Currency; 20 character maximum)
    Instructions:
  • What is the neighborhood's median housing price?
  • *Neighborhood Crime Rate
    (Number; 15 digit maximum)
    Instructions:
  • What is the violent crime rate in the target neighborhood?
  • Neighborhood Plan
    *Plan Year
    (Number; 15 digit maximum)
    Instructions:
  • What year was the plan developed?
  • *Plan Duration
    (Number; 15 digit maximum)
    Instructions:
  • What is the duration of the plan (number of years)
  • *Plan Development
    (Paragraph; 2000 character maximum)
    Instructions:
  • Describe how the plan was created, including how it incorporated resident involvement.
  • *Resident Participation Level
    (Number; 15 digit maximum)
    Instructions:
  • How many residents participated in the creation of the plan?
  • *Project Integration
    (Paragraph; 2000 character maximum)
    Instructions:
  • Describe how the proposed project fits into the neighborhood plan and the organization's strategic plan.
  • *Consultant Name
    (Paragraph; 2000 character maximum)
    Instructions:
  • If outside consultants were used in developing the plan, who were the lead consultants? If the planning process was primarily facilitated by internal staff, please list the primary staff person(s) responsible for the plan's creation and his or her planning background.
  • Required Attachments
    You are required to submit supplemental documents for this application.

    Electronic copies of these documents under 1 MB can be attached to application by using the "Upload File" links below. If you do NOT have an electronic copy of these documents you may mail them to:
    Wells Fargo Regional Foundation
    Attn: Neighborhood Development Grants - Phase I
    123 South Broad Street, 3rd Floor, PA4360
    Philadelphia, PA 19109
    Please answer the questions on the left to indicate if you are attaching the document to this application or if you will be mailing the document to us.


    Additional Instructions to upload your electronic document to the online application:

    1. Click on the 'Upload File' link
    2. A File Upload window will appear, click the "Browse" button in order to select the file from its current location on your computer.
    3. Select the file from your computer and click the "Open" button.
    4. Click the "Upload File" button to attach your document to the application.
    5. Click the "Done" button to close the File Upload window.
    Please be sure that your file is smaller than 1 MB.
    *Implementation Budget Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Implementation Budget
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Detailed neighborhood plan implementation budget (Please indicate amount requested from Wells Fargo Regional Foundation. For other costs, please specify funding sources, if known.)
  • *Organization Budget Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Organizational Budget
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Organization's current detailed operating budget.
  • *IRS Letter Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • *Attach: IRS Letter
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Copy of most recent IRS determination letter.
  • *Officers/Directors Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Officers/Directors
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • List of officers and directors of the organization with affiliations.
  • Annual Report Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Annual Report
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Current annual report (if available).
  • *Audited Financials Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Audited Financials
    (File Upload; 2,097,152 byte limit)
    Instructions:
  • Annual audited financial statements (past three years).
  • Interim F/S Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Interim F/S
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Most recent interim financial statements.
  • *Neighborhood Plan Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Neighborhood Plan
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Current comprehensive neighborhood plan.
  • *Form 990 Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Form 990
    (File Upload; 10,485,760 byte limit)
    Instructions:
  • Most recently filed IRS form 990 including schedule A (can be downloaded from guidestar.org).
  • *Conflict of Interest Policy Submittal
    (Single-Select List)
  • Electronic
  • Mail
  • Not Available
  • Instructions:
  • Attach: Conflict of Interest Policy
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Conflict of interest policy for board and officers.
  • Application Assessment
    The Wells Fargo Regional Foundation is committed to improving the quality of our grantmaking program. Please take a moment to answer the following questions to assist us in enhancing our program. Thank you.
    How did you hear about the Wells Fargo Regional Foundation?
    (Checkbox List)
  • Wells Fargo Regional Foundation Website
  • Wells Fargo Employee
  • Wells Fargo Regional Foundation Grantee
  • Word of Mouth
  • Conference
  • Neighborhood Planning Workshop
  • Other
  • Instructions:
  • How did you hear about the Wells Fargo Regional Foundation?
  • Have you attended the Wells Fargo Regional Foundation's neighborhood planning workshop?
    (Yes/No)
    Instructions:
  • Have you attended the Wells Fargo Regional Foundation's neighborhood planning workshop?
  • Was the neighborhood plan funded by the Wells Fargo Regional Foundation?
    (Yes/No)
    Instructions:
  • Was the neighborhood plan funded by the Wells Fargo Regional Foundation?
  • Need Support?