THE GONZALES TRUST ORGANIZATIONAL REQUEST FORM Survey

Gonzales Trust Organization Application

Requests will be presented quarterly to the Gonzales Trust Committee for review, then forwarded to The Arc US for final approval. Requestees will be notified within 10 days of Arc UW review. You may be contacted If more information is necessary for consideration.

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

1.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:

EIN # (9 digits):

2.Have you received this grant three times before? If yes, list dates and amounts. Example: In 2021, we received $30,000 to hire a full time instructor for our Down Syndrome adaptive classes. (Required.)

Yes

List dates and amounts of previous grants through the Gonzales Trust Organization category.

3.List each item and amount for which you request funding.(Required.)

4.Provide a narrative for the budget items listed above. Describe in detail the purpose and intended use of requested funds. Example: $20,000 would fund tutoring and academic support for 20 Down Syndrome youth annually.(Required.)

5.How will the requested funds benefit people with Down syndrome? Example:
specialized help with reading, math, and school readiness.

(Required.)

6.When do you need this funding? Is your request time sensitive? If yes, explain with dates and details. Example: our tutoring and support begins in August.

7.How will this funding fulfill an unmet need for people with Down syndrome? Example: Students with Down syndrome benefit from individualized instruction that is slower-paced, incorporates repetition and reinforcement, and uses multisensory approaches such as visual, hands-on, and verbal learning.(Required.)

8.How is this program or service innovative? Include an explanation in how it differs from existing programs regarding purpose or mechanism of delivery. Example: A tutoring program for students with Down syndrome is innovative because it delivers highly personalized, evidence-based instruction tailored to their unique learning profiles, rather than relying on standard, one-size-fits-all educational approaches.(Required.)

9.List the total amount of your request (must not exceed $40,000)(Required.)

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

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

12.How will you evaluate the impact of the program? Include how you will track participation, use of services, frequency and duration of services, and/or other data and impact.(Required.)

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