Sample illinois Speaks Micro-Grant Proposal Form



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SAMPLE Illinois Speaks Micro-Grant Proposal Form



Welcome! This is the proposal form for applying to Illinois Humanities to host an Illinois Speaks public dialogue or series of public dialogues. (There is a different form if you are applying for a Vision, Action or Multiplier Grant.) We’ve tried to make this as simple an application process as possible; we want you to be out there facilitating public discussions as soon as possible!


The purpose of Illinois Speaks micro-grants is to allow more people of all ages throughout the state of Illinois to host public discussions about issues that matter in their communities.
People who are excited about trying this out but are new to Illinois Speaks are encouraged to apply for a single event. Those who have already been awarded Illinois Speaks grants or are experienced in moderating or facilitating public dialogue can apply for multiple events.
All applicants must discuss this application with a Host Organization, and agree on program elements and how grant money will be spent before submitting.
Remember that all Illinois Speaks award winners must go through an Illinois Humanities facilitator training before their event, including a segment on evaluation. After the event, two forms should be completed: an online evaluation on a mobile device for audience members and a follow-up report by the host organization point person.
Our Suggested topics for 2016 are “Water and the Public Good,” “The Future of Public Education,” and “The Aftermath of Ferguson, Mo.” You are welcome to pitch variations of these topics or other topics altogether if you like. Good luck!
This SAMPLE form is for your convenience only – a place for you to create, edit, and save your proposal before submitting it online by copying and pasting the information into the appropriate fields of the online form. This form will NOT be accepted as a submission.
If you have any questions or problems with the application process, please reach out to Mark Hallett at mark.hallett@ilhumanities.org for assistance or visit ilhumanities.org/grants.
HOST ORGANIZATION INFORMATION

Illinois Speaks public conversations must happen in partnership with a nonprofit organization. Grant payments do not go to individuals, they go to this host organization. Eligible groups are nonprofits, schools, libraries, churches, universities or colleges, and schools.


*Host Organization Name:
*Host Organization Address:

Street Address:


Address Line 2:
City: State: Zip:
Federal Employer Identification Number (EIN):
*Host Organization Point Person:

First: Last:


*Point Person Email:
* Point Person Phone (include area code):
* Point Person Phone Type: Mobile, Home, Work, OR Other
APPLICATION'>ADDITIONAL APPLICANT INFORMATION
*Is the Host Organization Point Person the only individual applying for this grant?

  • If yes, skip to the APPLICATION section on the following page

  • If no, complete the information below about the additional applicant

*Name of Applicant:

First: Last:
*Address:

Street Address:


Address Line 2:
City: State: Zip:
*Email:
*Phone (include area code):
*Phone Type: Mobile, Home, Work, OR Other

Note: The additional applicant listed above must discuss this application with the Host Organization and agree on program elements and how grant money will be spent before submitting.
APPLICATION
*I am applying to host a (choose one):

Single public dialogue ($250) OR Four public dialogues ($1,000)


Note: If you have chosen the “Four public dialogues ($1,000)” option, you must make the case that you have experience moderating or facilitating public conversations in the PROPOSAL NARRATIVE section below.
*Proposal Narrative:
Tell us about the facilitator, any experience the facilitator has hosting or moderating discussions, the topic to be discussed, the plan to get 10 or more people to attend, the partner institution or venue, and how the Illinois Speaks micro-grant will be spent (maximum 300 words):





APPLICATION (cont.)

*In the online form, you are asked to select up to THREE key audience categories targeted your public dialogue program. from the following list.




African-Americans




Artists, Collectors, Etc




Asian-Americans




Business/White Collar




Community Leaders




Criminal Offenders




Economically Disadvantaged




Elderly




General Audience




Government Officials




Health Care




Labor Group/Blue Collar




Latino




Native Americans




Post secondary – College




Post secondary – Graduate




Professional Group




Religious Leaders




Rural




Scholars




Social Services




Students/Youth




Teachers: K–12




Towns & Villages




Women




Urban




Other




The following fields apply to requests for “Single public dialogue ($250)” grants only.
*Event Name: 



*Event Description for Website (maximum length: 75 words): 





*Event Date and Time: 





*Event Location: 





*Event Location Address:

Street Address:
Address Line 2:
City: State: Zip:
APPLICATION (cont.)

The following fields apply to requests for “Four public dialogues ($1,000)” grants only.


*Event Series Name: 



*Event Series Description: 





*Event Series Dates and Times: 





*Event Series Location(s) including physical address(es): 








ACCESSIBILITY

Illinois Humanities is committed to making events as accessible and inclusive as possible. We are offering an additional $100 to accepted grant requests in order to help provide accessible services for individuals with disabilities. Such accessible services might include American Sign Language Interpretation and accessible media.

*Do you wish to be considered for this additional grant?

If yes, please describe your plan to make your event accessible for individuals with disabilities (maximum 75 words):





If yes, also describe how you plan to reach out to people with disabilities in your community (maximum 75 words):









Information saved here should be copied and pasted into this online form and submitted for consideration.

* = Required


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