ERNEST E. JUST
YOUTH & COMMUNITY SERVICES, INC.
P.O. BOX 10741
OAKLAND, CA 94610
Grant Proposal Request Form
This form is to be used by Chapters and Organizations seeking funding
from the Ernest E. Just Youth & Community Servics, Inc. (EEJYCS) for
specific mentoring and commuity service related programs/events.
Submit completed form to Charles Peevy: [email protected]
Program/Event Title:
Organization:
Are You a 501c3 Organization? (Yes/No):
Contact Name:
Phone Number:
Address:
Fax:
City:
State:
Zip Code:
Email:
Brief Program/Event Summary (Highlights of program/event)
Where will this event be held?
Event Date
List of activities to be provided
How many expected
participants?
Event Cost
Estimate
# of years have you been doing this
program/event?
ΏΨΦ only - Has an event checklist
been completed? (Yes/No)
Community to be Served
(Check all that apply)
Type of Program
College or Trade School
Prep/Awareness
Tutoring
a) Facility Costs
b) Food Costs
7 years old and younger
8-14 years old
Job Training
15-18 years old
c) Transportation
d) Other
Life Skills
College Students
TOTAL Event Costs
Health Awareness
New Parents
Other
______________
EEJYCS Grant Funds
Requested
Seniors
Applicant Contribution
Other _________________
Other Confirmed Partners You’re Utilizing
Name:
Organization:
Phone:
Email:
Name:
Organization:
Phone:
Email:
Name:
Organization:
Phone:
Email:
Have you received funding from EEJYCS before? (Yes/No)
If yes, when, for what, how much?
EEJYCS Grant Proposal Form
Rev 2/2012
Have you participated in EEJYCS events in the past?
(Yes/No)
If yes, when? What was your level of participation?
[email protected]
www.eejycs.org
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Program/Event Title:
Organization:
Brief Program/Event Description (Include who will do the program/event and who will be the recipients. What is
needed for the program/event to succeed? Where will the program/event occur? When the program/event occurs, what
is the schedule for activities? How will you measure the success of the program/event? And why should the EEJYCS
support this program/event?
1. Brief Program/Event Description (include who will conduct the program/event and who will be the main
beneficiaries.
2.
What is needed for the program/event to succeed?
3.
Where will the program/event occur?
4.
When the program/event occurs, what is the schedule for activities?
5.
Is this is single event (i.e. annual conference, trip) or is it part of a larger series (i.e. year-round afterschool
tutoring program)? Explain.
6.
How will you measure the success of the program/event? Survey, evaluation form, etc.
7.
Why should EEJYCS support this program/event?
8.
Describe what is needed for the program/event, how many will be served and how this program/event will
benefit the participant?
9.
What specifically will the money be used for within the program/event budget?
10. Other Information pertinent to the program/event?
EEJYCS Grant Proposal Form
Rev 2/2012
[email protected]
www.eejycs.org
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