Blandin Community Broadband Program Broadband Innovation Grant Application Instructions

• 
  Conducting a community technology survey
  
• 
  Holding a community technology fair
  
• 
  E-Commerce/Technology training for business
  
• 
  Community web portals
  
• 
  Public access labs and/or hot spots
  
• 
  Digital inclusion activities, including computer refurbishing and redistribution projects
  
• 
  Two-way video applications for home healthcare, education, etc.
  

Equipment purchases will not be funded except in the context of implementation of an innovative projects designed to advance use of the technology outside of institutional settings.

Blandin Foundation will use the following criteria to determine project selection:

1. 
   Project meets an identified community need.
   
2. 
   Community partnerships are evidenced in the proposal.
   
3. 
   Project increases the technological vitality of the community.
   
4. 
   Project uses appropriate technology for the stated purpose.
   
5. 
   Priority consideration will be given to projects that provide community-wide cross-sector benefits.
   

The maximum grant is $25,000. All projects require matching funds of at least 25% (1:3) of total project cost (for example, a $10,000 grant requires $3,333 match.) Projects demonstrating at least 1:1 match will be viewed favorably. Projects should be designed as to be able to track and report matching funds.

Application materials should be prepared simply and economically, avoiding the use of elaborate promotional materials beyond those sufficient to provide a complete, accurate and reliable presentation.

Submittal Date:

Name of organization:

Legal name, if different:

Address:

City, State, Zip:

Employer Identification Number (EIN):

Phone:

Title:

Email:
Name of contact person regarding this application:

Title:

Phone:

If no, is your organization a public agency/unit of government? Yes / No

If no, list name for fiscal agent:

Fiscal agent address:

Fiscal agent’s EIN:
Proposal Overview

Duration of project: ________/_______ to ________/_________

Month Year Month Year
Please give a 2-3 sentence summary of request:
Budget Summary

Fiscal Year of Organization: ___________to___________

Month Month
Total project budget: $

Total dollar amount requested of Blandin Foundation: $

1. 
   Organization Information
   
   1. 
      Brief summary of organization history, current mission, activities, and accomplishments.
      
   2. 
      Is your organization best positioned to do the proposed work? Are there opportunities to work together with other organizations for increased impact?
      
   3. 
      Describe what steps your organization takes to include a broad range of perspectives from the community you seek to serve such as board and staff members from diverse backgrounds.
      
   4. 
      Identify specific steps your organization takes to improve organizational effectiveness.
      

2. 
   Purpose of Grant
   
   1. 
      Background
      
      1. 
         Describe how your proposal fits the goals and evaluation criteria of the Broadband Innovation Grant program (listed above).
         
      2. 
         What organizations and individuals are involved in planning and implementing the project? How will you include community members who have historically not been represented in decision making in your community?
         
      3. 
         What key relationships will need to be developed that will allow the project to overcome obstacles it faces?
         
   2. 
      Implementation
      
      1. 
         What are the goals of your project?
         
      2. 
         What strategies and activities will be employed to achieve these goals?
         
      3. 
         Who will carry out these activities? Do they have the requisite skills and experience?
         
      4. 
         What are long-term strategies (if applicable) for sustaining this effort?
         

3. 
   Assessment
   

1. 
   Describe what success looks like and how you will measure success (use goals and metrics wherever you can.)
   
2. 
   How will you know you’ve reached your project’s goals?
   
3. 
   Give specific examples of how your project/program contributes to a healthy rural community.
   
4. 
   Explain the process that will be used to measure and document whether progress is being made toward achieving your project’s goals.
   

4. 
   Budget and Sources of Funding
   
   1. 
      Provide a brief statement of the amount and type of resources that will be needed to see this project through, and steps you are taking to mobilize the necessary resources.
      

5. 
   Attachments (please attach the following):
   
   1. 
      A copy of your organizational budget.
      
   2. 
      Project budget; please submit a detailed project budget including both sources of income for the project (indicate if these funds have been secured or are pending) as well as major expense categories. Be certain to include cash and in-kind matching contributions to the project. Feel free to attach a narrative explaining your numbers if necessary.
      
   3. 
      Most recent financial statement, from a formal audit if available, showing actual expenses. This information should include a balance sheet, a statement of activities (or statement of income and expenses) and functional expenses. If a formal audit is available, please include the management letter. This audit may be submitted electronically by providing a link to this information.
      
   4. 
      Brief description of key staff, including qualifications relevant to the specific request. Also provide information on the number of staff and volunteers in the organization.
      
   5. 
      IRS Form W9: https://www.irs.gov/pub/irs-pdf/fw9.pdf