2024 ICSSBM Grant Application
WELCOME
Thanks for your interest in the Indiana Commission on the Social Status of Black Males (ICSSBM) Grant Program. The mission of the ICSSBM is to develop strategies to assist or remedy severe adversities and make appropriate recommendations to improve the educational, social, employment, health, and other material conditions and circumstances for Indiana Black males. The Commission reviews the status of Black males in five principal focus areas: Criminal Justice, Education, Employment, Health, and Social Factors. The information provided within this grant application allows the Commission to make an informed decision while maintaining a record of all grant applications for future reference. If a field does not apply, insert “NA.” All information provided is kept confidential. Please complete this grant application and submit all requested documents to vgiles1@icrc.in.gov by Monday, November 4, 2024.
Part One: Organization
Name of Organization
Vision Statement
Mission Statement
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Website
Name of Representative
Representative's Phone Number
Please enter a valid phone number.
Representative's Email
example@example.com
Part Two: Project Overview
Title
Project Description
Who is your target population?
Please share what Indiana Counties will receive services through your efforts.
Goals
Expected Outcomes
Projected Timeline
Part Three: Statement of Work
What research and data support why this project will result in the expected outcomes?
How will you accomplish the expected outcomes and goals listed above?
Explain the potential barriers to success and how you will overcome them.
Part Four: Project Evaluation
How will you measure the success of your project?
How will you track and collect data based on your stated goal outcomes?
Part Five: Demonstration of Funding Needed
What is the total amount of funding you are requesting from ICSSBM?
If you don't receive the total amount requested, how will you fund the project?
What need does your project seek to address and why?
Part 6: Mission Alignment
How does your project align with the Commission's mission?
Which of the Commission's five focus areas does your project address and why?
Part 7: Additional Documents
In addition to this application please submit the following documents: Certificate of Incorporation, Detailed Budget, W9 Documentation, and Direct Deposit Document.
Certificate of Incorporation
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Detailed Budget
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W9 Document
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Direct Deposit Document
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Submit
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