NEIGHBORHOOD IMPLEMENTATION RENEWAL APPLICATION
Wells Fargo Regional Foundation 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)
  • FT Employees
    (Number; 15 digit maximum)
    Instructions:
  • Number of Full-Time Employees
  • PT Employees
    (Number; 15 digit maximum)
    Instructions:
  • Number of Part-Time Employees
  • *Operating Support
    (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.
  • *Staff Leadership
    (Paragraph; 2000 character maximum)
    Instructions:
  • Provide a brief description of key staff leaders, responsibilities, and background (short bio).
  • *Development Stage
    (Single-Select List)
  • Start-Up
  • Emerging
  • Growing
  • Mature
  • Instructions:
  • Please check the category which best describes the development stage of the organization.
  • *Greatest Challenges
    (Paragraph; 2000 character maximum)
    Instructions:
  • What are the greatest challenges your organization faces in its current stage of development, and how do these challenges affect its ability to deliver services/projects and its ability to raise funds?
  • Project Details
    *Project Title
    (Text; 255 character maximum)
    Instructions:
  • (255 character limit)
  • *Project Description (short)
    (Paragraph; 2000 character maximum)
    Instructions:
  • Short Project Description (one paragraph).
  • *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 Implementation Renewal Grants are funded over 24 months.
  • *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.
  • 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:
  • *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.
  • *Attach: Project Partners
    (File Upload; 524,288 byte limit)
    Instructions:
  • Please list ALL of the partnerships the organization has developed with other organizations/agencies/resident groups for this project.

    Detailed Instructions:
    1. Click the link below to SAVE the Partners Chart template to your computer.

      Download the Partners Chart

    2. Complete the Partners Chart template, and save your changes.
    3. Click the 'Upload File' link to attach your document to this application.
    4. You will need to BROWSE to locate the file on your computer. Select your file and select the 'Open' button.
    5. Click on the 'Upload File' button.
  • *Project Sustainability
    (Paragraph; 2000 character maximum)
    Instructions:
  • Describe how this project will become sustainable after the grant period. What additional resources will it take to sustain the project over time?
  • Project Outcomes
    *Community Impact
    (Paragraph; 2000 character maximum)
    Instructions:
  • Briefly explain the overall, ultimate impact the project will have on the community.
  • *Project Impact To Date
    (Paragraph; 2000 character maximum)
    Instructions:
  • What have been the project's quantifiable activities and impact to date? How do they compare to the original plan?
  • *Project Challenges
    (Paragraph; 2000 character maximum)
    Instructions:
  • What challenges have you faced in implementing the project, and how did you manage them?
  • *Neighborhood Indicators
    (Paragraph; 2000 character maximum)
    Instructions:
  • Neighborhood indicators measure the health and vibrancy of the neighborhood. Tracking the changes in the neighborhood indicators can be a tool by which to make decisions about the neighborhood revitalization strategy. We understand that some neighborhood indicators are easier to measure than others.

    Please review our list of neighborhood indicators.

    After reviewing the list, what two to three neighborhood indicators have been used to track the impact of the overall project to date, and what (if any) progress has been made during the initial grant period?
  • *Anticipated Project Impact
    (Paragraph; 2000 character maximum)
    Instructions:
  • What are the anticipated activities and impact during the next two years?
  • *Attach: Project Milestones and Activities
    (File Upload; 524,288 byte limit)
    Instructions:
  • Detailed Instructions:
    1. Click the link below to SAVE the Project Milestones and Activities template to your computer.

      Download the Project Milestones and Activities Template

    2. Complete the Project Milestones and Activities template and save your changes. For each project component, please include key milestones and outputs.
    3. Click the 'Upload File' link to attach your document to this application.
    4. You will need to BROWSE to locate the file on your computer. Select your file and select the 'Open' button.
    5. Click on the 'Upload File' button.
    This spreadsheet will be used to keep track of the major milestones and outputs related to the grant request and key events that may impact the implementation of the neighborhood plan. Refer to the definitions and examples that are listed.

  • (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?
  • *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 Update
    (Paragraph; 2000 character maximum)
    Instructions:
  • How have the demographics and characteristics of the neighborhood changed during the initial implementation grant period?
  • *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 Update
    (Paragraph; 2000 character maximum)
    Instructions:
  • Have there been significant changes in the plan, and how have you handled them?
  • Other Required Attachments
    You are required to submit supplemental documents for this application. Templates have been provided for some of these documents.

    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:
    Wachovia Regional Foundation
    Attn: Neighborhood Implementation Renewal Grant
    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.



    (No input required)
    Instructions:
  • *Attach: Officers/Directors
    (File Upload; 524,288 byte limit)
    Instructions:
  • *Attach: Organization Budget
    (File Upload; 524,288 byte limit)
    Instructions:
  • *Attach: Overall Neighborhood Plan Implementation Budget
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Detailed Instructions:
    1. Click the link below to SAVE the Implementation Budget template to your computer.

      Download the Overall Neighborhood Plan Implementation Budget Template

    2. Complete the Implementation Budget template and save your changes.
    3. Click the 'Upload File' link to attach your document to this application.
    4. You will need to BROWSE to locate the file on your computer. Select your file and select the 'Open' button.
    5. Click on the 'Upload File' button.

  • (No input required)
    Instructions:
  • *Attach: Detailed Project Budget
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Detailed Instructions:
    1. Click the link below to SAVE the Detailed Project Budget template to your computer.

      Download the Detailed Project Budget Template

    2. Complete the Detailed Project Budget template and save your changes.
    3. Click the 'Upload File' link to attach your document to this application.
    4. You will need to BROWSE to locate the file on your computer. Select your file and select the 'Open' button.
    5. Click on the 'Upload File' button.

  • (No input required)
    Instructions:
  • *Attach: Key Locations
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Detailed Instructions:
    1. Click the link below to SAVE the Key Locations template to your computer.

      Download the Key Locations Template

    2. Complete the Key Locations template and save your changes.
    3. Click the 'Upload File' link to attach your document to this application.
    4. You will need to BROWSE to locate the file on your computer. Select your file and select the 'Open' button.
    5. Click on the 'Upload File' button.
  • 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.
  • Attach: Letters of Support
    (File Upload; 1,048,576 byte limit)
    Instructions:
  • Letters of support.