Contact Information Organization Name * Mailing Address
* County * CT - Fairfield NJ - Bergen NJ - Essex NJ - Hudson NJ - Hunterdon NJ - Middlesex NJ - Monmouth NJ - Morris NJ - Ocean NJ - Passaic NJ - Somerset NJ - Sussex NJ - Union NJ - Warren NY - Bronx NY - Dutchess NY - Kings NY - Nassau NY - New York NY - Orange NY - Putnam NY - Queens NY - Richmond NY - Rockland NY - Suffolk NY - Sullivan NY - Ulster NY - Westchester Primary Contact Person * Honorific * Mr. Ms. Mrs. Dr. Title * Phone * Email *
McDonald's Owner/Employee Endorsement
McDonald's Contact Phone Number
To what extent have you worked with your McDonald's contact? (If applicable)
Organization Information Legal Name of Organization *
As it appears on 501(c)(3)
Employer ID Number (EIN) * Organization Type * Academic/Education: College/University Academic/Education: Elementary School Academic/Education: Foundation/Education Academic/Education: Head Start Academic/Education: High School/Secondary School Academic/Education: Learning Center Academic/Education: Middle School/Jr. High Academic/Education: Preschool Academic/Education: Special Needs School Academic/Education: Other Advocacy: Animal Welfare Advocacy: Child Abuse Prevention Advocacy: Civil Rights Advocacy: Court Appointed Special Advocate Advocacy: Disabilities Arts & Culture: Aquariums Arts & Culture: Dance Arts & Culture: Drama/Theater/Opera/Perf. Arts Arts & Culture: Literary Arts Arts & Culture: Museum Arts & Culture: Music Arts & Culture: Public Television Arts & Culture: Visual Arts Arts & Culture: Zoo Arts & Culture: Other Civic & Social: Adoption Agency/Foster Care Civic & Social: Camp Civic & Social: Child Care Civic & Social: Community Center Civic & Social: Counseling Center Civic & Social: Drug and Substance Abuse Civic & Social: Family Services Civic & Social: Food Bank Civic & Social: Foundation Civic & Social: Fraternity/Sorority Civic & Social: Group Home Civic & Social: Guilds/League Civic & Social: Homeless/Shelter Civic & Social: Independent Living Civic & Social: Law Enforcement Civic & Social: Library Civic & Social: Park District Civic & Social: Preservation/Conservancy Civic & Social: Other Community: Athletics Community: Boys & Girls Club Community: Boys Club Community: Girls Club Community: Scouts Community: YMCA Community: Youth Organization Community: YWCA Health Care: Burn Center/Institute Health Care: Disabilities Health Care: Equestrian Center Health Care: Federally Qualified Health Center Health Care: Health Center/Clinic Health Care: Hospice Care Health Care: Medical Camps/Cancer Camps Health Care: Rehab Center Health Care: Research Institutes Health Care: Respite Care Health Care: Specialty Care Center Health Care: Other Other: Disaster Relief/Emergency Services Other: Government Agency Other: Professional Association Other: Religious Organization Other: RMH Chapter Other: RMHC Chapter Organizational Mission Statement * Brief Description of Organization: Background and Significance *
Please familiarize us with your organization, e.g., how and when it was founded, whom it serves, your primary endeavors, etc.
Proposal Request Project Name * Requested Amount * Program Area * Arts, Culture & Humanities: Aquariums Arts, Culture & Humanities: Dance Arts, Culture & Humanities: Drama Arts, Culture & Humanities: Literary Arts Arts, Culture & Humanities: Museum Arts, Culture & Humanities: Music Arts, Culture & Humanities: Theater Arts, Culture & Humanities: Other Civic & Community: Camp Civic & Community: Community Development Civic & Community: Fire Safety Civic & Community: Law Enforcement Civic & Community: Library Civic & Community: Playground Civic & Community: Urban Renewal Civic & Community: Other Disaster/Emergency Services: Refugee Assistance Disaster/Emergency Services: Relief Services Disaster/Emergency Services: Other Education: Curriculum/Materials Education: English as a Second Language (ESL) Education: Field Trip Education: Lekotek/Compuplay Education: Literary Programs Education: Scholarships Education: Tutoring Programs Education: Other Environment/Nature: Animal Welfare Environment/Nature: Green Programs Environment/Nature: Nature Preserve Environment/Nature: Recycling Environment/Nature: Other Health/Medical: Adaptive Equipment Health/Medical: Autism Programs Health/Medical: Cancer Camps/Medical Camps Health/Medical: Dental Care Programs Health/Medical: Medical Education Health/Medical: Medical Procedures/Operations Health/Medical: Medical Research Health/Medical: Physical Impairment Programs Health/Medical: Rehabilitation Programs Health/Medical: Screenings Health/Medical: Sexual Health Health/Medical: Vision Programs Health/Medical: Visiting Professorships Health/Medical: Other Healthy Lifestyle: Athletics/Sports Healthy Lifestyle: Nutrition Healthy Lifestyle: Physical Recreation Programs Healthy Lifestyle: Prevention Programs Healthy Lifestyle: Other Social Welfare: Bullying Prevention Social Welfare: Child Abuse Prevention Social Welfare: Child Care Social Welfare: Child Safety/Security Social Welfare: Clothing Programs Social Welfare: Counseling Social Welfare: Domestic Violence Social Welfare: Food/Hunger Programs Social Welfare: Foster Care Social Welfare: Housing/Shelter Social Welfare: Independent Living Social Welfare: Legal Counseling Social Welfare: Parenting Programs Social Welfare: Other Technology: Basic Computer Applications Technology: Basic Computer Techniques Technology: Computer Hardware/Software Technology: Computer Safety Technology: Internet Training Technology: Other Youth Development: Leadership Skills Development Youth Development: Mentor Programs Youth Development: Peer Support Youth Development: Recreation Programs Youth Development: Self Esteem Programs Youth Development: Other Type of Support * Clinical Services Conferences/Seminars Construction/Building/Renovation Curriculum/Training Disaster Relief Emergency Funds Expansion Furniture General Operating Expenses/Non-Clinical Medical Equipment Medical Research Multi-Media Non-Medical Research Production Expenses Program/Project Support Safety/Security Scholarships Technology Temporary Housing Transportation/Vehicle Tuition Number of Children Served *
How many children would benefit from this particular project?
Age(s) of Children Served (in percentages)
0-3 yrs 4-8 yrs 9-12 yrs 13-18 yrs 19-21 yrs All ages Target Population:
Demographics of Children Served (in percentages)
Aboriginal % Arabic/Middle Eastern % Asian % Black/African Descent % Black/Caribbean % Caucasian % East Indian % First Nation % Hispanic % Latino % Maorio % Multi-Racial % Native American % Native Hawaiian/ Pacific Islander % Other % Previous Funding *
Has your organization received funding in the past from RMHC NYM? (Formerly RMHC NYTSA)
If yes, please list all previous funding (month/year) and amount(s). Project Objectives and Aims
Briefly state the broad, long-term objectives of this project, and describe what the project in this application is meant to accomplish.
Project Description *
Provide a detailed description of the need or problem to be addressed with this project, how the project will address those needs, the specific purpose of the funds requested, and what is unique about your project.
Indicate how your organization will evaluate the program if funded, e.g., survey, questionnaire, test results, etc.
Describe your plans for funding this project in the future. If other funding sources are already in place, please include that information in the fields below.
Has your organization applied for funding from other grantors for this project?
If yes, please list pending and/or secured funding for this project. RMHC NYM Grant Application Supporting Documents Cover Letter * Accepted file types: pdf, jpg, gif, png.
On stationery, signed by the senior management official, briefly outlining the organization's background, the nature of the proposal and request, a concise description of the needs, the specific purpose of the funds requested, and the amount requested.
Endorsement Letter Accepted file types: jpg, gif, png, pdf.
From a McDonald's employee or licensee, or RMHC Trustee (if applicable). Letters of endorsement are not required for grant consideration.
IRS 501(c)(3) Letter of Determination * Accepted file types: pdf, jpg, png, gif. Specific Project Budget * Accepted file types: pdf, jpg, gif, png.
This must be a detailed account of the proposed cost of your project (not your total programming budget). Your detailed Project Budget must specify how the requested grant monies will be allocated, and must equal the amount of grant monies you are requesting. Failure to itemize proposed expenditures may result in the decline of your application.
Organization's Operating Budget * Accepted file types: pdf, png, jpg, gif. Organization's Balance Sheet * Accepted file types: pdf, png, jpg, gif. Organization's Audited Financial Statements * Accepted file types: pdf, png, gif, jpg. Organization's most recently filed IRS Form 990 * Accepted file types: pdf, png, gif, jpg. Past Donor Information * Accepted file types: pdf, png, jpg, gif.
A list of private, corporate and foundation support over $500 during the past 12 months. If this information is embedded in above mentioned financial documents, please submit a separate sheet with your list of Past Donors.
Board of Directors List * Accepted file types: pdf, png, jpg, gif.