SAGES Education & Research Foundation Grant Application Are you submitting a grant for a SAGES Committee?*YesNo General Instructions & Guidelines: Resources It is assumed that some of the resources required to conduct the project are available through the applying institution. The grant funding will provide supplemental support for personnel, equipment, or services required for project completion. Criteria Awards are based on the educational and/or scientific merit of the project, the project director’s capability, and the likelihood that the project will be completed successfully. Responses The application questions reflect the interests of the SAGES Foundation, but are not intended to be conclusive. Answers should be concise but thorough. Reports If a grant is awarded, all payments are contingent upon a satisfactory progress report of said activities. The progress report must be submitted upon completion of the funded project, or no later than 6 months from the date funding was received, whichever comes first. A progress report template will be provided to all funded applicants. A. NARRATIVE 1. Organization Organizational information:*Organization's history:*Organization’s mission and goals, long-range plans:*Outline current programs and activities:*Major Accomplishments:* General Instructions & Guidelines: Please structure your proposal to provide the following information. A. NARRATIVE 1. Purpose of Grant/ Project Description 2. Purpose of Grant/ Project Description Describe the proposed program or project:*Identify the needs to be addressed, number of people to be served by the project:*Project goals and objectives:*Timetable for implementation:*Evaluation: Describe the plan to document progress and results. Provide specific, detailed metrics to show effectiveness and/or success of project.*2. Project Director/Project Managements/Committee Specify if the project is a new or continuing program:*Identify other organizations, partners, or funding agencies participating in the project:*3. Principal Investigator, Project Management, VenueName the principle investigator (if the project is research oriented) and list their qualifications:*Name the project manager and list their qualifications:*Name any additional professionals participating in the project management or operations:*Where will the program/project be actualized? Provide qualifications of the institution or venue (if different from the organization):*Evaluation - Describe the plan to document progress and results. Plan should delineate the metrics used for evaluation. Final evaluation and expenditure reports will be required for each grant awarded:*Name the Project Director and his/her academic institution:*Name any additional committee members or SAGES members participating in the project:*B. ATTACHMENTS 1.Project budget including: Travel Equipment, hardware, software Supplies and materials Printing and copying Telephone and fax Postage and delivery Project Management fees 2. Income-Include all confirmed and anticipated sources of revenue and indicate status. Provide an income total. Other foundation grants Corporate or individual donations or grants Project income, sales or fees In-kind support Project BudgetAccepted file types: pdf, doc, docx.IncomeB. ATTACHMENTS Please include the following attachments: 1. Copy of the current IRS determination letter indicating 501(c)(3) or 501(c)(6) tax-exempt status 2. Organizational structure, including: List of officers and directors, including academic or professional affiliations Description of committees and task forces Resumes and/or job description of key personnel involved in the project 3. Financial information, including: Project budget; refer to the Grant Application Budget Outline attached List of other funding agencies and potential funding sources and amounts committed or requested individual contributions and other sources of income supporting the project Current board-approved annual operating budget for the organization or department Most recent annual financial statement 4. Optional-Letters of support that substantiate need for the project and collaboration with other organizations GRANT APPLICATION BUDGET OUTLINE An accurate, detailed budget for proposed projects is required. Please break down the total budget into the specified items listed below. A narrative description explaining unusual budget items and, if applicable, the percentage of "overhead" applied to the project should precede the itemized listing. "In-kind" expenses and donations or matching funds should also be described. As long as the application contains the following information, it can be submitted in any format (word, excel, pdf, etc.). A. HEADING Please specify the budget period, e.g., calendar year (Jan. – Dec.) or fiscal year (July – June) B. EXPENSES Please itemize the following expenses and include any additional items relevant to your particular project. Provide an expense total. Salaries and wages by individual position, specifying full- or part-time positions Payroll taxes Fringe benefits and related fees Consultant and professional fees, e.g., accounting, legal, etc. Travel Equipment, hardware, software Supplies and materials Printing and copying Telephone and fax Postage and delivery In-kind expenses Project overhead (the Foundation allows up to 15%) TOTAL EXPENSES: C. INCOME Please include all confirmed and anticipated sources of revenue, and indicate their status. Provide an income total. Government grants and contracts Other Foundation grants Corporate or individual donations or grants Project income, sales or fees In-kind support Other revenue TOTAL INCOME: IRS Determination Letter*Accepted file types: pdf, worddocument.Organizational Structure*Accepted file types: pdf, excel, worddocument.Financial Information*Accepted file types: excel, worddocument, pdf.Letters of Support (Optional)Accepted file types: worddocument, excel. SAGES Education & Research Foundation Grant Application Cover Sheet Date of Application:* Date Format: MM slash DD slash YYYY Name of SAGES Committee Applying:* SAGES Committee Chair:*SAGES Committee Chair E-mail:* Legal Name of Organization Applying:*Should be the same as on IRS determination letter and as supplied on IRS Form 900 First Middle Last Title Year Founded:*Current Annual Operating Budget:*Executive Director:*Executive Director E-mail:* Contact Person/ Title (if different from Executive Director): First Middle Last Title Principle Investigator/ Project Coordinator:* First Last Principal Investigator/Project Coordinator E-mail:* Address (Principal/Administrative Office):* Mailing Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Website:* Project Name:*Purpose of Grant (one sentence):*Beginning and Ending Dates of the Project:*Amount Requested:*Total Project Cost:*Geographic Area Served:*Upload related attachmentsAccepted file types: worddocument, pdf, excel, jpeg, png.Upload related attachmentsAccepted file types: worddocument, pdf, excel, jpeg, png.Upload related attachmentsAccepted file types: worddocument, pdf, excel, jpeg, png.Upload related attachmentsAccepted file types: worddocument, pdf, excel, jpeg, png.