Grant Application

We would like to thank you for your interest in submitting your organization’s grant application to Newborn Hope, Inc.

Newborn Hope Grant Applications are now accepted online. You may also submit a grant application via mail.

Grant applications must be postmarked no later than March 1st.

*Please note our grant deadline has changed.

Only complete applications will be considered. Please click here to download the grant application Word Doc.

Our evaluation tool will give you a better understanding of how Newborn Hope, Inc. evaluates applications.

Online Grant Application

Please Note: you can save your progress by clicking “Save and Continue Later” at the bottom of this form. Incomplete applications will not be accepted.

Upload your IRS Determination Letter including 501(c)(3) or 509(a) tax-exempt status*
File Types Allowed: PDF or JPG Only. Max Size: 2MB
Accepted file types: pdf, jpg, Max. file size: 2 MB.
Applicant Organization Summary
Organization Name*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
EIN*
Website*
Executive Director*
First Last
Phone*
Email*
Application Contact Person (if other than Executive Director)
First Last
Title
Phone*
Email*
Grant Request Information
Purpose of Grant
- To provide ongoing care to women with high-risk pregnancies.
- To provide transport or care to critically ill newborns and their families.
- To perform research into prematurity prevention or the care of premature infants.
- To provide equipment to care for premature infants.
- Other
Brief Description of Request:*
Amount of Request: $*
Fiscal Year:*
Financial Information
Sources of Income Table
Complete the table below for your organization as a whole, based on the most recently completed fiscal year. Use the "Explain Other funding Sources" box for 'Other Sources'.

Funding Source:
Percentage from Government grants (federal, state, county, local)*
Please enter a number from 0 to 100.
Percentage from Government contracts*
Please enter a number from 0 to 100.
Percentage from Foundations*
Please enter a number from 0 to 100.
Percentage from Business*
Please enter a number from 0 to 100.
Percentage from Events (include event sponsorships)*
Please enter a number from 0 to 100.
Percentage from Individual contributions*
Please enter a number from 0 to 100.
Percentage from Fees/earned income*
Please enter a number from 0 to 100.
Percentage from Workplace giving campaigns*
Please enter a number from 0 to 100.
Percentage from In-kind contributions (optional)
Please enter a number from 0 to 100.
Percentage from Other Funding Source
Please enter a number from 0 to 100.
Total (Must equal 100%)
Explain Other Funding Sources
Only use if your Source of Funding is not listed above.
Expense Table
Complete the table below for your organization as a whole, based on the most recently completed fiscal year.

Budget Spent On
Percentage for Management/Operating*
Please enter a number from 0 to 100.
Percentage for Programs and Services*
Please enter a number from 0 to 100.
Percentage for Fundraising*
Please enter a number from 0 to 100.
Percentage for Other*
Please enter a number from 0 to 100.
TOTAL (must equal 100%)*
Explain Other Expense Budget
Use the "Explain Other Expense Budget" box for 'Other Expenses'.
Name*
First Last
Signature*
Date*
MM slash DD slash YYYY
Current Financial Statement
Upload Current Financial Statement
Max size 2MB and File Types Allowed: PDF
Accepted file types: pdf, Max. file size: 2 MB.
Narrative
Preferred not to exceed three pages
Organization Background*
Describe the organization and its founding, development, mission, geographic area served, goals and objectives.
Vision Story*
Include a brief description of or story about how a grant from Newborn Hope, Inc. will personally help an individual or group. This can be a fictitious situation – it will help Newborn Hope, Inc. understand the vision for the requested grant.
Project Request*
Describe, in detail, the project and the amount of funding requested.
i. Outline the need for the project. Include the issue and/or opportunity addressed.
ii. Describe activities planned to accomplish goals and evaluation of project.
iii. Document as a new or ongoing activity.
iv. Identify the target population and numbers served.
i. Outline the need for the project. Include the issue and/or opportunity addressed. ii. Describe activities planned to accomplish goals and evaluation of project. iii. Document as a new or ongoing activity. iv. Identify the target population and numbers served.
Timeline*
Outline a timetable for implementation of proposed project.
Evaluation*
Provide specific outcome measures that will be used to evaluate the impact of the project on the targeted population.
Budget*
Itemize a budget for proposed project.
Partnership*
Describe at least 2 ways that the project will provide public recognition of Newborn Hope, Inc.
Collaboration*
Indicate whether aid has been sought or received from other organizations during the past year.
i. Identify other organizations participating in the project.
Planning*
Describe the challenges and opportunities facing the organization in the next three to five years.
Optional
Include any additional information that is vital to convey in this proposal.
Grant Report
If your organization received funding from Newborn Hope in the last year, a grant report needs to be submitted by March 1.*
Please check one.
- Applicable
- Non-applicable
Upload Final Report
File Allowed: PDF Max size: 3MB
Accepted file types: pdf, Max. file size: 3 MB.
List Your Board of Directors*
Click the (+) to add additional names
Title Name
Names and Qualifications of Key Staff*
Click the (+) to add additional names
Name Qualifications
Annual Report*
Your organization’s most recent available report, if available.
File Type Allowed: PDF Max Size 2MB
Max. file size: 2 MB.
Email
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Grant Application

Online Grant Application

Grant Application

Applicant Organization Summary

Grant Request Information

Financial Information

Expense Table

Current Financial Statement

Narrative

Grant Report

Thank You To Our Statewide Sponsors

News & Happenings

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NBH Impact Video

Title	Name

Name	Qualifications