Community Impact Grant Application

For eligible organizations whose work directly benefits Texans living with profound autism and their families.

Initial application: The Foundation may request a determination letter, budget, financial statement or Form 990, board list, project budget, annual report, and other supporting documentation during review.

1. Organization information

Legal name *

DBA, if applicable

Mailing address *

Website

Tax ID / EIN *

Year established

501(c)(3) status *

Mission statement *

Primary contact name and title *

Email *

Phone *

2. Funding request overview

Project or program title *

Amount requested *

Funding type

Preferred disbursement timeline

One-time request?

If no, explain

Brief summary of request *

3. Project details

Detailed description, goals, timeline, and activities *

How does this work improve the lives of individuals living with profound autism? *

Target population and Texas geographic area served *

How will funds be used? Include major budget categories. *

Expected outcomes and measures of success *

Plans for sustainability after funding ends

Other funding received?

If yes, list sources and amounts

4. Organizational capacity

Full-time staff

Volunteers

Annual operating budget

Most recent fiscal year income

Most recent fiscal year expenses

Leadership and governance

Relevant experience executing similar work

Collaboration and referral partnerships

5. Certification

I certify that the information provided is true and complete to the best of my knowledge.I understand that submission does not guarantee funding.If funded, the organization agrees to use the award solely for the approved purpose and provide reasonable financial, expenditure, and outcome reporting requested by the Foundation.

Authorized representative name and title *

Typed signature *

Date *