Thank you for your interest in the CareSource Foundation.

• The full proposal is below. Please use these questions as the template for your proposal.
• Cut and paste the questions into your own Word document before submitting.
• Answer all questions and attach the required financial documents.
• Proposals received without these requirements will be deemed ineligible.
• Please limit your response to no more than five pages.

All grant proposals must be submitted through the online proposal process.
When completed, please send proposal AND attachments to: CareSourceFoundation@csmg-online.com

1. Your Organization
   • Non-profit Organization Name and Website
   • Contact Name, Address, Email and Phone Number
   • 501(c)(3) Federal ID Number (i.e. 31-XXXXX)
2. Organization Mission
   • Brief description of organization’s history, purpose & general activities
3. Focus Area (Into which of the four Foundation focus areas does your proposal fit?)
   • Issues of the Uninsured
     • Access to affordable healthcare
     • Prescription drug assistance
     • Screening and detection
     • Special needs assistance
   • Community Health Issues
     • Human and social services, such as:
       • Domestic violence
       • Child abuse
       • Hunger
       • Homelessness
       • Preventative Care
   • Critical Health Trends
     • Children’s health issues, such as:
       • Juvenile diabetes
       • Asthma
       • Obesity
       • Immunization
     • Health & wellness
       • Education
     • Resources for key providers (child care, school nurses, after-school programs)
   • Collaboration with Other Foundations & Funders
     • Network of organizations and case workers who can identify those with greatest needs
     • Partnerships with area health care providers and other Foundations
4. Clearly describe the program or initiative for which funding is requested. Include the following detail in your narrative:
   • What is the plan? How will it work?
   • What are your objectives?
   • Who is the target audience?
   • Is anyone else addressing the need? Are you partnering with anyone to accomplish your goals?
   • What will be different as a result?
   • Do you have any special qualifications or history that will assist in achieving your goals?
   • Describe your strategy for permanent financial support
   • How will you communicate progress and/or outcomes with the Foundation?
5. Connections
   • Have you had previous grants from the CareSource Foundation?
   • Are there any CareSource employees on your Board or committees?
6. Financial Information
   • Amount of Request
   • Total Project Budget
   • Do you receive support from United Way?
   • Do you receive support from any government resources?
7. Required Attachments
   • Current Balance Sheet
   • Current Cash Flow Statement
   • Current Sources of Income
   • Most recent audited financials

We hope this helps in your grant preparation process!

Questions? Contact Cathy Ponitz at cathy.ponitz@csmg-online.com or (937) 531-2808.
Thank you for your grant request to the CareSource Foundation. Your work is important and we wish you continued success!