ATTACHMENT B
FY 2027 Budget Nonprofit Funding Request- Application
ORGANIZATION INFORMATION
Are you a 501 (c)(3) nonprofit organization? ☐Yes
☐No
Organization Name
Year Founded
EIN (Tax ID#)
Contact Person, First and Last Name
Title
Email Address
Phone Number
Mailing Address
Website
ABOUT YOUR ORGANIZATION
What is the mission of your organization?
Number of Employees ☐Full-Time Staff
☐Part-Time Staff
☐Volunteers
In the last two years, have you been awarded a grant or other direct funding by the City? If so, explain.
Are you qualified to apply for the Human Services Resource Allocation Program (HSRAP), Community Development Block Grant (CDBG), or Emerging Needs grant programs? If so, did you apply? Explain why or why not.
PROGRAM & COMMUNITY IMPACT
Name of Program: Grant Request Amount: $ Please provide a narrative describing your proposed program (no more than 200 words):
Total Number of people estimated to be served by this
program:
Total number of Palo Alto residents estimated to be
served by this program:
Total number of Palo Alto residents estimated to be served by your agency:
Total number of unduplicated Palo Alto residents
estimated to be served by the requested funding
amount:
EQUITY IMPACT
Does Will your organization proposed program serve historically underrepresented or underserved populations? If yes, please describe. (ex. Number or percent of demographic populations)
What measures does your organization take to promote services to underserved populations? ☒Social Media ☐Website
☐Location of program/services ☐Direct mail
☐Other: (Please describe)
What fees will be charged for proposed services, if any? Will subsidized or fee waivers be offered to clients?
ALIGNMENT WITH CITY COUNCIL PRIORITIES
Briefly describe how your request supports one or more of the City Council Priorities (2-3 sentences). If not relevant indicate with “N/A.”
Climate Action and Adaptation & Natural Environment Protection:
Economic Development and Retail Vibrancy:
Implementing Housing Strategies for Social & Economic Balance:
ATTACHMENT B
Public Safety, Wellness & Belonging:
PROGRAM GOALS
Attachment 1: Please use the template below to list up to 3 goals related to the program(s) you are proposing with requested funding. In a separate Attachment 1, for each goal identify 1-3 strategies your organization will implement to achieve this goal. For each strategy, provide an objective and an outcome.
Example:
Goal: A general statement about the desired long-term impact.
Example: "Enhance STEM education access for underrepresented middle school girls in underserved areas.” Strategy: The overall approach or method used to achieve the goal.
Example: "Partner with local schools to develop and deliver hands-on STEM workshops led by female science professionals.”
Objective: Specific, measurable actions that need to be completed to reach the goal. Example: "Train 20 female STEM professionals to facilitate workshops reaching 100 middle school girls per year.” Outcome: The positive change or result that occurs as a direct consequence of the project activities. How will you know that the strategy is successful?
Example: "An increase in the number of girls expressing interest in pursuing STEM careers post-workshop participation.”
Describe your organization’s plan for evaluating the program’s effectiveness? Include any specific measurement tools to be used such as surveys or other tools. (no more than 200 words)
PROGRAM SUSTAINABILITY BUDGET
What amount $ and percent % of your organization’s budget is currently funded by the following:
If the full funding request is not awarded, would the program remain viable with partial funding? (Y/N) ☐Government Grants$_____, ___%
☐Private Donations$_____, ___%
☐Fundraising$_____, ___%
☐Membership Fees$_____, ___%
☐Fees for service$_____, ___%
☐Other $_____, ___%
What percentage of your organization’s annual budget does the grant request represent? Annual Budget: $____
Grant Request Amount: $____
Percent of Budget: (Grant request/Annual Budget) x100 = ___% If awarded, will the contribution be used to leverage other funding opportunities? Explain (1-2 sentences).
Attachment 2- Proposed Budget. Describe specifically how the requested funding will be used.
REQUIRED ATTACHMENTS
Attachment 1: Program Goals Attachment 3: IRS Determination Letter (501 (c)(3) Attachment 2: Proposed Budget Attachment 4: IRS Form 990*
REPORTING REQUIREMENTS
*Requests of up to $510,000- brief annual report (1-2 pages) summarizing key activities and community impact highlights. -Financia reporting will consist of a self-certification of compliance with grant terms.
Requests $510,000-$25,000-
-Annual report on service outcomes
and performance metrics.
-IRS Form 990
Requests $25,000+-$100,000-
-Semi-annual reports on service
outcomes and performance metrics.
- IRS Form 990
Requests $100,000+
-Quarterly service outcomes and
performance metrics, and a year-end
community impact report.
- IRS Form 990
ATTACHMENT B
ATTACHMENT B
ATTACHMENT 2: Program Goals
Please use the template below to list up to 3 goals related to the program(s) you are proposing with requested funding. In a separate Attachment 1, for each goal identify 1-3 strategies your organization will implement to achieve this goal. For each strategy, provide an objective and an outcome.
Example:
Goal: A general statement about the desired long-term impact.
Example: "Enhance STEM education access for underrepresented middle school girls in underserved areas.”
Strategy: The overall approach or method used to achieve the goal.
Example: "Partner with local schools to develop and deliver hands-on STEM workshops led by female science professionals.”
Objective: Specific, measurable actions that need to be completed to reach the goal. Example: "Train 20 female STEM professionals to facilitate workshops reaching 100 middle school girls per year.” Outcome: The positive change or result that occurs as a direct consequence of the project activities. How will you know that the strategy is successful?
Example: "An increase in the number of girls expressing interest in pursuing STEM careers post- workshop participation.”
Goal #1:
Strategy(s)-
Objective(s)-
Outcome(s)-
Goal #2:
Strategy(s)
Objective(s)
Outcome(s)
Goal #3:
Strategy(s)
Objective(s)
Outcome(s)
ATTACHMENT B
ATTACHMENT 2: FY 2027 (July 1, 2026-June 30, 2027)
Proposed Budget
FY2027
Total Program Expense
Budget
Total Program Expense
Budget for
Requested Funding
Program Name:
Salaries-
Overhead (insurance, rent, phone,
etc.)-
Insurance
Audit
Rent & Utilities
Maintenance/Repair
Phone
Consultants-
Staff Development & Training
Travel & Meetings
Information Technology
Equipment
Office Supplies & Materials
Printing & Publishing
Direct Services-
Direct Subsidy-
Other-
Other-
Total
Add any additional program budget sheet(s) here, as needed.
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ATTACHMENT B
ATTACHMENT B
ATTACHMENT 3: IRS Determination Letter 501(c)(3)
Please attach determination letter to application email, clearly labeled Attachment 3.
ATTACHMENT B
ATTACHMENT B
ATTACHMENT 4: IRS Form 990*
Please attach to the application email, your organization’s 2025 IRS Form 990, or 2024 IRS Form 990 if 2025 has not yet been filed.
*Funding requests < $510,000 do not need to submit an IRS Form 990.
ATTACHMENT B
ATTACHMENT B
Signature(s)
The undersigned certifies the information contained in this proposal is true and accurate to the best of their knowledge and belief. The undersigned warrants that they have authority on behalf of the organization they represent to enter into this proposal, warrant its accuracy, and bind the organization to the applicable terms and conditions.
Name of Authorized Signer: Click or tap here to enter text.
Title: Click or tap here to enter text.
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Date: Click or tap here to enter text.
Name of Authorized Signer: Click or tap here to enter text.
Title: Click or tap here to enter text.
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