Disney Worldwide Conservation Fund Annual Grants
2014 Cybergrants Application Preview
Please be advised that this document cannot serve as your formal application for DWCF
funding. Please consider this template a resource to help gather information you will be
asked to provide in the Cybergrants online application system.
Charity Information – Basic
Please note that information requested is for the US 501(c)(3) nonprofit organization. All
information in this section is required unless otherwise noted.
• Legal Name of US 501(c)(3)
This could be the name of a DBA, or a chapter that operates under the national organization's
Federal EIN number and 501(c)(3) status.)
• Primary Phone Number
• Fax
• E-mail Address
• Website Address
• Name of Executive Director, CEO, Principal or Other Lead Executive
• Email address of Executive Director, CEO, Principal or Other Lead Executive
• Are there any Board Members of The Walt Disney Company affiliated with your organization?
Please visit the link for a current list of The Walt Disney Company Board Members: Click Here
• Annual Budget (Not required unless specifically requested)
• Audited Financial Statement (Not required unless specifically requested)
• Anti-Discrimination Statement (Not required unless specifically requested)
• IRS 501(c)3 Determination Letter (Not required unless specifically requested)
• Annual Report (Not required unless specifically requested)
• W9 Form & Non Profit Information
(Download and complete the W9 form provided with the online application. Scan as an electronic
file, save file name as W9NameofOrganization and attach to the application by clicking the
“Upload” button and follow the instructions)
*Note to past applicants: If you have previously applied, your most recent W-9 will be
shown in your file. Please check to make sure all information is correct in this document.
If necessary, please upload an updated W-9.
Non-US Organization
If you are an organization applying via a US-intermediary, please provide the following information
about the non-US organization.
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Non-US
Non-US
Non-US
Non-US
Organization
Organization
Organization
Organization
Name
Contact Person and email address
Address: City, State/Province, Country
Phone Number
• Intermediary Approval (Check box will be provided on the website in order to confirm that the US
organization has agreed to act as an intermediary on your behalf this year.)
• Intermediary Approver Name (Please provide the name of the person who has approved you to use
this US organization as an intermediary.)
• Intermediary Approver Email (Please provide the email address of the person who has approved you
to use this US organization as an intermediary.)
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Disney Worldwide Conservation Fund Annual Grants
2014 Cybergrants Application Preview
Charity Information – Mission
The following bullet points refer to the U.S. 501(c)(3) organization which would be receiving the
donation. All information in this section is required.
• Organization Type
Please select one option from the drop-down list provided on the website.
• Mission Statement and Goals (2000 character maximum)
• Services Provided (2000 character maximum)
Please provide a brief description of the services your charity offers.
• Geographic Region/Area Served
Please provide name of region(s) served. This information is for reporting purposes only. It does
not affect the contribution decision-making process.
• Ethnic Groups Served
Group categories will be provided on the website. Enter whole numbers only, total must equal
100%. This information is for reporting purposes only. It does not affect the contribution
decision-making process.
• Population/Demographic Served
A list will be provided on the website, please select all that apply from the list provided. This
information is for reporting purposes only. It does not affect the contribution decision-making
process.
• Gender Served
A list will be provided on the website, please select all that apply from the list provided. This
information is for reporting purposes only. It does not affect the contribution decision-making
process.
• Age Group Served
A list will be provided on the website, please select all that apply from the list provided. This
information is for reporting purposes only. It does not affect the contribution decision-making
process.
• Income Range of Population Served
A list will be provided on the website, please select all that apply from the list provided. This
information is for reporting purposes only. It does not affect the contribution decision-making
process.
• How many recipients are served in the average year?
• If this is a membership organization, how many members?
• Name other charities or other organizations to which you provide support
Type each name in the text box provided on the website and click the "Add to List" button. If
none, please type "None" in the text box and click the "Add to List" button.
Contact Information
Multiple contacts may be added online. Contacts can be edited or deleted before the application is
submitted. All information in this section is required.
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•
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Salutation
First, Last Name
Contact Type (A drop down menu of options will be provided)
Title or Position
Occupation (If different from title or position)
Relationship to Organization (This field describes the relationship the requestor has to the
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Disney Worldwide Conservation Fund Annual Grants
2014 Cybergrants Application Preview
requesting organization.)
• Address, City, State, Zip, Country
• Telephone, Fax, E-mail Address
Charity Information – Board
Please note that the governance information requested is for the U.S. 501(c)(3) nonprofit
organization. All information in this section is required.
• If you have a Board, please list their names.
If none, please type “None” in the text box field provided on the website.
• If you have an Advisory Board, please list their names.
If none, please type “None” in the text box field provided on the website.
• Please list names of any Disney, ABC, or ESPN employees currently serving your organization as
board members, executive officers or with any significant affiliation.
If none, please type “None” in the text box field provided on the website and click the “Add to
List” button.
• Please describe their involvement.
• Employee Benefit
Conflict of Interest Statement: would any current or past employee of Disney, ABC, or ESPN
receive any direct benefit (monetary, tangible or otherwise) as a result of a donation to this
charitable organization?
• If a current or past employee will benefit, please provide the employee's name and explain benefit.
(2000 character maximum)
Delivery Information
The following bullet points refer to the U.S. 501(c)(3) organization to which the donation would be
delivered to. All information in this section is required.
• Delivery Organization Name
• Address 1 (Must be a shipping address within the United States. No P.O. Boxes)
City, State/Province, Zip
• Delivery Contact First, Last Name
• Email Address
• Phone Number
• Email Address
• If delivery address provided is different from that of the registered 501(c)(3) charitable organization
making the request, please indicate the reason why
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Disney Worldwide Conservation Fund Annual Grants
2014 Cybergrants Application Preview
Request Information
All information in this section is required unless otherwise noted.
• Project Title (Please enter the name of the project. Maximum 5 words)
• Principal Investigator Name
• Requested Cash Amount (Please enter valid dollar amounts only up to $25,000. While the DWCF
prefers to fund comprehensive conservation programs, funding requested from Disney does not need
to cover every piece of the project.)
• Primary Country where project takes place (A drop down list or available options will be provided on
the website)
• Species (General name of species targeted)
• IUCN Species Status (A drop down list of available options will be provided on the website)
• Connecting youth and families with nature (Does your project have objectives focused on connecting
youth with nature? You will be able to choose from a drop down menu with the options of: Yes or No)
• Project Description (A concise description of your project that you would want us to use to
summarize your work should we provide funding. Maximum 500 character limit)
• Overall Conservation Program (The goal of the Disney Worldwide Conservation Fund is to support
long-term holistic conservation programs which include working with local people and decision-makers
for lasting sustainability. The focus is on comprehensive conservation programs rather than short-term
research projects.
1.
Provide a narrative of your comprehensive program (long term efforts/initiatives) that includes
the background or need for this project, how this project contributes to the conservation of
species and/or habitats, and how it incorporates field research and community conservation
education to attain your conservation objectives. Please provide an overview of the work rather
than the specific methodology; those details can be provided in the methods section of this
application for work to be conducted in the upcoming year. We do occasionally fund startup
programs; if this applies to your program, indicate your long-term conservation plans and how
this project may lead to the development of a sustainable conservation program for a species or
habitat. If this project will be a part of an established program in the area you will be working,
provide those details.
2.
Then, state the specific components of the work you are asking Disney to fund this year (work
to be done in 2014-2015).
(Maximum 5000 character limit)
• Project Personnel (List project personnel/organization and their role, identifying responsibilities for
research, education, animal welfare and conservation impact: Name, organization if applicable,
responsibilities. Maximum 10000 character limit)
• Project Goals and Objectives (Define the specific goals and objectives as they relate to field
research, community involvement/education and conservation for this proposal. Maximum 10000
character limit)
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Disney Worldwide Conservation Fund Annual Grants
2014 Cybergrants Application Preview
• Project Outcomes (Optional: Tell us your estimated outcomes for this year's work by completing
the following fields. Unless otherwise stated, each metric refers to outcomes you aim to accomplish
this year and each is optional so choose only those that apply to your work. At the end of this section
you can add any additional metrics relevant to your project that you feel are missing from our list
(please do not exceed 5 additional metrics and be sure to include unit of measurement). You will be
asked to state your performance against these goals in your final report.)
Species population increase (%)
Habitat to be protected (sq. km)
Number of people engaged through community
outreach efforts
Number of youth engaged in conservation
through program objectives
Number of local people you plan to employ in
conservation
Number of people engaged in economic
development opportunities
(Create your own metric)
• Research Methods (Describe your research methods for work to be done in the upcoming year,
including information such as sample sizes, general methodology, statistical analysis/evaluation
methods, and the feasibility of attaining goals with proposed methodology. Maximum 10000 character
limit)
• Education Methods (Describe your education methods for work to be done in the upcoming year,
including information such as target audience, sample sizes, general methodology, learning tools,
statistical analysis/evaluation methods, along with plans to respond to those findings and the
feasibility of attaining goals with proposed methodology. Maximum 10000 character limit)
• Conservation Methods (Describe your conservation methods for work to be done in the upcoming
year, including information such as methods to effect conservation change, involve local stakeholders,
influence decision makers locally, regionally, internationally, statistical analysis/evaluation methods,
and the feasibility of attaining goals with proposed methodology. Maximum 10000 character limit)
• Animal Welfare (For background on the guidelines related to animal welfare that we refer to visit:
Click Here If an animal is to be captured or restrained please provide a description including where
applicable specific: Capture/restraint techniques to minimize stress and the potential for physical
injury or psychological harm; Immobilization/anesthesia techniques, identifying a specific veterinarian
or other trained professional; Anesthetic/analgesic administration techniques to minimize exposure to
noxious stimuli and presumptive effects where appropriate. Maximum 3000 character limit)
• Animal Type (A drop down list with available options will be provided on the website)
• Project Start Date
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Disney Worldwide Conservation Fund Annual Grants
2014 Cybergrants Application Preview
• Project End Date
• Previous Project Funding (Was this project funded by the DWCF last year?)
• If yes- a progress report will be required
• If no- two (2) letters of support will be required
• Project State(s) (For U.S. based programs, please select the state(s) where project is taking place.
If the project is located outside of the U.S., select "Not Applicable")
• Geographical Coordinates (Provide the geographical coordinates of the project site (i.e. longitude
and latitude in the following format: N 71.23.27, W 071.38.08)
• Photo Upload (Upload 1 .jpg or .pdf photo representing the project species or habitat that may be
used in DWCF publications, websites, social media etc. By uploading this photo, I certify that I hold all
rights in and to this photo and that it does not violate the Terms of Use)
• Social Media Pages (Please provide your organization/project social media pages (e.g. Facebook,
Twitter). If you have none please write none.)
• Timetable (Please upload an outline timetable for data collection and analysis here.)
• Literature Cited (If referencing other scientific work in your proposal please include relevant
literature citations here in alphabetical order. Maximum 10000 character limit)
• Background (Please upload the curriculum vitae of the Primary Investigator (PI) and the co-PI.
Please do not upload more than 5 relevant publications authored for each person.)
• Budget (Please justify the cost for any budget items that have large costs associated with them in
your uploaded file. Please provide a detailed budget for the upcoming year, funding requested from
Disney should not exceed $25,000. Budget should be divided into 4 columns of funding: Funding
requested from Disney; Funds obtained/secured; Balance required; Total project cost. Please round
total request to the nearest $50 US. Preference is given to funding in-country expenses rather than
airfare and salary, but these other expenses will be considered with appropriate justification. Please
ensure that any item referred to in the budget is mentioned somewhere in the application
methodology sections.)
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