Application Checklist

(based on the Colorado Common Grant Application)

Preferred applications are brief and to the point. This checklist is provided to aid you in completing your application. Please complete and attach all requested information to your application. Only complete proposal applications will be considered.

A. INFORMATION FORM

Download this form and complete the Summary of Applicant Organization and the Program/Project Budget. (Click here to download PDF. Adobe Reader is required.)

B. COVER LETTER

One page tailored to address the amount requested and how the funds will serve the interests and specific priorities laid out in Valleylab's annual focus.

C. ORGANIZATIONAL INFORMATION

Mission statement with goals and objectives

Brief summary of the organization’s history

Current programs, activities, and accomplishments

Funding / grant application history with Valleylab

D. PROJECT DESCRIPTION

Brief statement of the issue to be addressed, geographic area to be served, target population, and how they will benefit

Specific purpose of grant request, i.e., operational capital or special request, and how it fits with Valleylab's annual focus

Amount of grant request

Goals and objectives of program

Timetable for program implementation

Other organizations providing financial support or participation for the proposed project

Long-term sources / strategies for funding at the end of the grant period

Specifically describe how volunteers will be used and number of volunteer hours available

E. EVALUATION

Submit a basic plan to evaluate the project that includes the following:

Expected results during the funding period

How success will be defined and measured

How project's results will be used and/or disseminated

F. ATTACHMENTS

List of Board of Directors with occupations and/or community affiliations

Organizational Summary Form (provided below)

Copy of original 501(c)(3) determination letter

Names and qualifications of key staff

Anti-discrimination statement adopted by board

Most recent fiscal year-end financial statements (audited if available)

Program / project budget (to include expenses and revenue)

Current agency budget including percentage of annual budget allocated to staffing

Annual report

List of major contributors (government, foundations, businesses, and individuals)

• Eligibility Guidelines and Limitations

Questions?

Valleylab Grants Administration
303-530-6584
www.valleylab.com
valleylab.cares@tycohealthcare.com

All proposals and requested attachments should be submitted to:
Valleylab
Mailstop GRANTS
5920 Longbow Drive
Boulder, CO 80301