E-Blast Submission Form

Chapter Grant Proposal Form and Submission
Date

MonthDayYear
Date
Chapter Name
State
Full Name

First NameLast Name
Tax ID
Number of Paid Members
Current President
President Elect
Treasurer
List five Chapter Members and their role that will be actively involved in this project:
Submit Your Current Chapter 990 Form:

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Submit Your Officer Roster:

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Submit Your Chapter Budget:

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Proposal Guidelines
1. Is this a new program? If no – explain what the outcomes from the first project were and provide justifications for repeating and/or expanding this program.
2. Proposal must not exceed 700 words.
3. Expected impact and outcomes must not exceed 700 words.
4. List up to three community partner(s).
5. Does or will the chapter have other funding from the community partners and/or the chapter budget to support this work? If yes what amount?
6. Include funder's name and address (NBNA will not contact funder).
7. Please list 1-3 NBNA's signature/mission driven programs that align with your project.
8. Please note: if your chapter is already receiving funds from one of these committees, you should not submit a grant requesting additional fundings.
Submit Your Proposal:

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Submit the Grant Budget:

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Additional Comments
For any questions or inquiries please contact Dr. Martha Dawson at madawson@bellsouth.net. Thank you for your participation!
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Chapter Grant Proposal Form and Submission