Applicant information

First name

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Last name

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Phone

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Phone type
Email address

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A.

Organization Information

Organization Name

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Country

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Year Established

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Primary Contact Name

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Title / Role

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Email Address

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Website

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Organization Type

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Total Members Served

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Total Assets (USD)

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Number of Staff

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B.

Project Overview

Project Title

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Project Start Date

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Project End Date

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Project Type

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Primary Topic Area (check all that apply)

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Primary Target Group (check all that apply)

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C.

Program Design

Number of Program Sessions / Events

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Duration per Session (hours)

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Delivery Format

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Will materials be translated? (Yes / No - list languages)

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Will program be documented? (Yes / No – describe method)

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Prior Experience (check all that apply)

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D.

Expected Outcomes & Reporting

# of communities reached

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# of direct beneficiaries

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# participants show improved knowledge (pre/post test)

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# savings accounts opened during project

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# participants referred to credit union products

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# instructors/volunteers trained

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Data Collection Method

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Will you use pre/post test?

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Visual documentation planned?

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E.

Brief Project Description

Answer each question in 3–5 sentences maximum. Focus on facts, numbers and outcomes.

What problem does this project solve? (Include relevant local data)

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Why is your organization best placed to implement this?

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How will this project continue after the grant period?

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F.

Budget Overview

Total Program Budget (USD)

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Requested from WFCU (USD) - up to $10,000

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Amount to be self-funded by your organization (USD)

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Other Funding Sources, if any (list name and amount in USD of each co-funder)

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Please describe how the funds provided by WFCU will be utilized.

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Confirmation

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