Delta Dental of Illinois Foundation community grants logo

Community Grants Program

The Delta Dental of Illinois Foundation's Community Grants Program is for charitable organizations with programs focused on improving the oral health of children in Illinois. Organizations may submit one application through the community grants program per calendar year. Grants cannot exceed $10,000 and must be for Illinois programs/organizations only.

Please read the Grant Guidelines and Philosophy section before completing this application. If you have any questions, please contact Lora Vitek, Director of Philanthropy and Community Relations at lvitek@deltadentalil.org.

2019 Community Grants Application

Please complete this form and submit on or before Friday, October 04, 2019 5:00 PM Central Time.
Please note, this application cannot be saved. Tip: Complete your application in Word, save, and copy/paste your answers into each field.

Date
Name of Organization
EIN
Primary Contact
First Name
Last Name
Title
Address
 
City
State
Zip
E-mail
Phone
Executive Director/President
First Name
Last Name
E-mail
Request Information

The Delta Dental of Illinois Foundation provides funding for programs and projects that meet one or more of the following objectives.

Please check all that apply:



All programs and projects must benefit Illinois children and/or communities. (For dollar amounts, please enter only numbers, do not enter any symbols.)

Organization Questions

Description of the Organization (limit 1000 characters)

What is your organization's written mission statement? (limit 500 characters)

Total organization budget for the current year? 

Does your organization serve Illinois exclusively? If no, what percentage of the population served by your organization are Illinois residents? What percentage of the population specifically served by the program/project identified in this grant application are Illinois residents? (limit 1000 characters)

What were your fundraising and administrative costs for the last completed year? You can calculate this number by dividing fundraising expenses plus management and general expenses by total expenses. (limit 500 characters)

What percentage of your Board of Directors supported the organization with a personal financial gift this past year? Does your organization have a Give or Get Policy for your Board of Directors? If not 100%, please explain. Please Provide Details (limit 500 characters)

Program/Project Specific Questions
Program/Project Title
  (limit 250 characters)
Amount Requested for the Program/Project
(maximum request - $10,000)
Total Budget of Program/Project:
Fiscal Year of Program/Project Funds will be utilized:

What specific oral health need in YOUR COMMUNITY does this program/project address? (limit 5000 characters)

Please provide a brief description of the program/project for which you are requesting funding. (limit 1000 characters)

Is this a new, ongoing or one-time program/project? (limit 250 characters)

Counties in IL in which the program provides services (CTRL+Click to select multiple):

How many Illinois children were served by this program/project during your last completed year? (if applicable) (limit 500 characters)

How many Illinois children will this grant request specifically serve? What ages? (limit 500 characters)

What other agencies are you working with on this program/project? (if applicable) Describe partnership or activities. (limit 1000 characters)

What are the specific outcome objectives, including target goals, of this program/project related to this funding? Please include information on how you will measure the impact of this program/project. (limit 5000 characters)

Please include the following documentation with your grant application. (Click here for instructions.)

Select file to upload (please combine multiple files into a single zip file [4MB limit per file])

  • Current year's organizational budget(include projected revenues and expenses. Please categorize expenses under programmatic, management and general, and fundraising).
  • Budget of proposed program/project for which you are requesting funding. (If the requested is for a specific program) Please indicate the specific items you plan to utilize DDIL Foundation funding.
  • Audited financial statements for the last fiscal year, or if unavailable, copy of Form 990.
  • Latest annual report or a summary of the organization's prior year's activities/outcomes.
  • Current Board of Directors list with related employment affiliations.
  • Copies of evaluation tools, if available.
  • 501(c)3 IRS determination letter
  • Progress Report (This is for 2016 DDIL Foundation grantees only, please click on ‘Current Grantee Report Form’ on the previous page)

File Upload Instructions

Please assemble all of your documents into no more than two zip files each can be no larger than 4MB in size. Once zipped, click Browse on the application form and select the file. The file will be uploaded with your application.

 

Should you need to submit documents separately, please email them to lvitek@deltadentalil.com by Friday, October 04, 2019 5:00 PM Central Time. Please also note your organization's name in the subject line.

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