Application for Funding

Organization Information

Organization's Legal Name*

The name the grant would be made out to.

Organization's Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Website Address*

Type of Organization*

Your type of organization can be an academic institution, such as a university or teaching hospital; a non-governmental (NGO) or not-for-profit organization; a registered charity; or a hospital or clinic.

If your organization is located in the USA, you must upload a copy of your IRS letter:

If your organization is located in Canada or another country, you must enter your charitable registration number:

Mission Statement*

DEI Statement

If your organization has a DEI (Diversity, Equity, and Inclusion) statement, please provide examples of how DEI is being addressed within your organization. Is it embedded in your mission statement, values and/or strategic plan? Do employment practices support DEI? Include the composition of senior leadership and the BOD if possible.

Most recent Annual Report (optional)

Allowable file types: .pdf, .doc, .docx

Have you previously applied for an OGS grant?*

Did you receive OGS funding?

How did you hear about OGS?*

Contact Information

Contact information for the individual who is responsible for the request:

Name*

First Last

Job Title*

Email*

This email address will be contacted for items pertaining to the funding application.

Enter Email Confirm Email

Phone

Enter international phone numbers here:

Use this field if the previous phone field does not have enough space.

Contact information for the person who is authorized to sign legal documents on behalf of the organization:

If different from the above

Name

First Last

Job Title

Email Address

Phone

Enter international phone numbers here

Use this field if the previous phone field does not have enough space.

Project Information

Project Title*

Project Specialty (select all that apply)*

Advocacy
Childhood Eye Care
Eye Care & Training
Optometry School Development
Optometry School Support
Vision Center Development
Vision Center Support
Vision Screenings, Eye Exams & Eyeglass Distribution
Other

If 'Other', please indicate:

In what country or countries will your project take place?*

Is your project a stand-alone project, or part of a long-term initiative?*

Project start date*

Project end date*

If your project is a part of a long-term initiative, for how long is the initiative going to run/or has been running? (YYYY/MM/DD to YYYY/MM/DD)*

Have any projects, similar to yours, already demonstrated that the initiative works? Please leave blank if you are unaware of any similar projects.

How will your project be managed, and by whom? Please include details of any relevant qualifications or experience.*

If your application is successful, you will be required to submit regular reports on the progress and achievements of your project. Will you be able to submit reports as required?*

Yes
No

If no, why?

Project Details

Unmet health needs your project aims to address*

Estimated number of people who will benefit from your project*

Target population for project*

If applicable, what facilities/equipment do you already have, and why they are no longer suitable for use (if you intend to replace them using OGS funding)

Please clearly define the objectives of your project, with milestones*

Provide steps you will take in implementing your project (inputs, activities, outputs, time frame)*

Please outline how you will measure and evaluate the impact of your project, with methods of reporting (short term outcomes, long term outcomes, impact)*

Please outline how you will ensure that the impact of your project will be sustained, and if it has local ownership*

Project Funding

What amount of funding does your project require? (in USD except Canadian organizations, use CAD)*

How will this funding be allocated? Please download this Excel template to complete both the Budget and Budget Narrative. Instructions are contained within the spreadsheet. Then upload it using the button below before submitting the completed application. Applications will be considered incomplete without this submission.

Please upload your completed Grant Budget Excel document*

Please indicate at what stage of your project the OGS funding will be spent (e.g., at project start, at 12 months, etc.)*

What is the total budget required to implement your project?*

If you require extra funding (beyond the OGS grant) to implement your project, please indicate how much funding you have secured and from what sources

If you have not yet raised all of the additional funds that you will need, please detail how you intend to raise this money

Optometry Giving Sight Application for Funding