Please Choose One of the Following Methods for Submitting a Completed Application

25 Halcyon Road, Millbrook, NY 12545 • 845.677.0644 GENERAL OPERATING SUPPORT GRANT APPLICATION Complete this application only if your organization was asked by the Dyson Foundation to submit a full proposal for general operating support. If not, please use the Foundation’s Letter of Inquiry form. Submitting the Letter of Inquiry is the first step in applying for Dyson Foundation funding.

For full instruction on the use of this form go to: www.dysonfoundation.org/grant-application-general- operating-support

Submission Date

Organization Name

General Operating Support Grant Application I. ORGANIZATION’S PROGRAMS OR CORE ACTIVITIES Describe the organization’s programs or core activities. How do these programs or core activities lead to the achievement of the organization’s mission?

General Operating Support Grant Application II. LEADERSHIP OF THE ORGANIZATION

Describe the organization’s governing board. Discuss the roles and responsibilities of the board and board members within the context of this organization. What board committees are in place, if any? How often does the board meet? What are the qualifications of the board leadership and members?

General Operating Support Grant Application III. MANAGEMENT OF THE ORGANIZATION Describe the organization’s administrative and management structure. What are the qualifications of the chief staff officer? What are the qualifications of other executive level staff?

General Operating Support Grant Application IV. EVALUATION & SUSTAINABILITY What are the organization’s plans for evaluating its effectiveness relative to its goals and mission? What are the organization’s long-term plans for financial sustainability?

V. STANDARDS OF BEST PRACTICE Please review the Dyson Foundation’s Standards of Best Practice on our website, and check the box below.

We have reviewed the Standards of Best Practice and are prepared to demonstrate that our organization is in compliance with these standards.

General Operating Support Grant Application VI. ATTACHMENTS Please include the following documents with your application. If this is a renewed request for funding, please submit only those supporting materials that the Foundation does not have on file or that have changed since your last application or report. Please contact the Foundation’s offices with any questions about what to include.

Financial Documents: The three most recent audited financial statements. The current fiscal year operating budget for the organization using our Organizational Budget Form. If you already prepare an organizational budget that approximates this format, please feel free to submit it in its original form. Current Balance Sheet (also called a Statement of Assets and Liabilities) and Statement of Activities (also called a Statement of Income and Expenses or a Profit And Loss Statement). A list of all nongovernmental sources of income of $25,000 per year or more for your current fiscal year and any future commitments. Feel free to annotate an existing list, but please indicate annual amounts, grant periods and, if applicable, any specific restrictions placed on the grants.

Other Supporting Materials: IRS determination letter of 501(c)(3) status, dated within seven years of this application A list of board members, their positions on the board, terms of office, and professional affiliations Profiles or résumés of key staff members An organizational chart Our Diversity Form Your most recent annual report No more than three of your most recent publications, news articles, or other relevant materials about your organization or the funded project. Please be selective.

Please choose one of the following methods for submitting a completed application. Please do not use more than one method.

Mail to: E-mail to: Fax to: Dyson Foundation 845.677.0650 [email protected] 25 Halcyon Road Millbrook, NY 12545

General Operating Support Grant Application