THE GONZALES TRUST ORGANIZATIONAL REQUEST FORM Survey

Requests will be presented quarterly to the Gonzales Trust Committee for review. Approved requests will be forwarded to The Arc of the United States for final approval. Requestees will be notified of the Committee’s decision. If more information is necessary for review, you will be contacted by Jennifer Espey, Executive Director, The Arc of New Mexico.

The following criteria apply to this request:

· Applicants must be non-profit 501(c) (3) organizations. Organizations do not necessarily have to be incorporated in New Mexico but must be authorized to do business and conduct activity in the state.
· Grants to non-profit organizations for innovative programs that directly benefit persons with Down syndrome and/or their families, guardians, or decision-making partners, in New Mexico. Grants will not be made for ongoing organizational overhead or routine programs. Grants are capped at $40,000 a year for any qualifying non-profit entity.
· Applicant organizations must demonstrate how the program/project:

· is solely for individuals with Down syndrome
· meets an unmet need for people with DS
· differs from other programs/projects offered to people with DS in New Mexico or differs in how the service is delivered
· advances inclusive community living, and/or
· addresses and helps to correct stigma and stereotyping of and about people with DS, and/or
· provides information and education to families, guardians, friends, teachers, employers, and others who interact with people with DS to support independent living

NAME AND ADDRESS OF ORGANIZATION(Required.)

Name/Company:

Address:

City:

State:

Zip Code:

Phone #:

E-mail:

Anticipated number of people to be served:

Signature of Requester

Print Name:

Proof of 501 (c) (3) status.

TOTAL AMOUNT REQUESTED INCLUDING TAX AND DELIVERY $(Required.)

The application will be assessed on the following criteria:

Applicant is a non-profit 501 (c) (3) organization.(Required.)

Yes

Organization is authorized to do business and conduct activity in the state of New Mexico.(Required.)

Yes

Grant is for ongoing organizational overhead or routine programs.(Required.)

Yes

Have you already received this grant three times before?(Required.)

Yes

Please describe what the funds being requested are for.(Required.)

What is the objective of this program? How will it benefit people with Down syndrome?(Required.)

How is the program fulfilling an unmet need for people with Down syndrome?(Required.)

How is this program innovative? Include an explanation in how it differs from existing programs regarding purpose or mechanism of delivery.(Required.)

How will the program be communicated to families and communities to elicit participation?(Required.)

How will the program help to correct stereotypes and stigma about people with Down syndrome?(Required.)

How will you evaluate the impact of the program?(Required.)

Budget breakdown: Until you send The Arc your budget breakdown, your request will be incomplete for consideration.(Required.)

I acknowledge that I must email a budget breakdown of the program to myoussef-arafat@arcnm.org for my application to be considered complete.

Is there anything else you believe is important about the program that you would like to share?