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Program Grant Application

Grants for a specific program that is ongoing or in development by a non-profit organization.

Every year, the Alexander S. Pissios Family Foundation allocates restricted funds to support programs for non-profit organizations that have proven their leadership, inspired change, and advanced the Foundation’s mission and vision.

This application is for Funding for a Program Grant from $2,000 to $10,000.

If you are requesting Event Funding from $500 to $2,500, please complete the Event Funding application.

Please note that grants in amounts over $10,000 are by Invitation Only by the Foundation.

Organizations may, in the sole discretion of the Foundation, receive one grant per year and renewals are not guaranteed.

Program Grant Application Deadlines

February 1 – May 1

August 15 – November 15

For more information about this grant program and application,  please contact:

Rosie Burke
Executive Director
Alexander S. Pissios Family Foundation
information@aspf.foundation

Step 1 of 7 – Eligibility

14%

* indicates a required field

Phone

This field is for validation purposes and should be left unchanged.

Eligibility

If any of the answers are “No,” the request may not be eligible for funding.

Is your organization a 501(c)(3) public charity?*

Yes

No

Is your organization based in Illinois?*

Yes

No

Is your organization a government entity?*

Yes

No

Does your organization have a non-discrimination policy in hiring staff or providing services based on race, religion, gender or gender identity, sexual orientation, age, national origin, or disability?*

Yes

No

Can you provide a current Illinois Charitable Organization Registration Statement (Form CO-1)?*

Yes

No

Can you provide a recent Form 990 or 990-N filed with the IRS, including Schedule A, or explain why none has yet to be filed?*

Yes

No

Will the organization be able to provide an annual report on Program outcomes?*

Yes

No

Does the purpose and goal of the Program align with one or more of the Foundation priorities?*

Check all that apply.

Providing education and workforce development for young adults with special needs that lead to self-sustaining job opportunities.

Providing programs to strengthen the relationship between Greece and the United States and develop, enhance, and preserve Greek culture, education, and language.

Providing sustainable employment opportunities to women-led single-parent households so that these parents and families can become self-reliant and prosper.

The Event does not align with one of these Foundation priorities

If any of the answers are “Yes,” the request may not be eligible for funding, but you may still submit it.

Is the funding request for a “pass through” organization to a third party or another program or project?*

Yes

No

Is the funding request solicitation for an annual contribution drive?*

Yes

No

Is the funding request for political activity of any kind, lobbying efforts, voter registration, or other activities that attempt to influence public elections?*

Yes

No

Does the funding request involve directing grants or scholarships to individuals?*

Yes

No

Is the funding related to a program that is being planned, in development, or not currently active?*

Yes

No

Is the funding related to or intended for existing debt or deficit funding?*

Yes

No

Does the funding request involve expenditures of capital improvements?*

Yes

No

Contact Information

Salutation

Name*

First Last

Title

Address*

NOTE: The Foundation primarily funds organizations based in Illinois.

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

Phone*

Email*

Contact Type*

Contact Description

If Other, please describe

About the Organization

Legal Name of the Organization*

Address*

NOTE: The Foundation will only fund organizations based in Illinois.

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

Phone*

Website

The organization is a registered 501(c)(3) in the State of Illinois.*

Note: in the Attachments tab of this application, you will be asked to upload proof of registration as a 501(c)(3). Failure to provide the requested documentation may result in the denial of your application for funding.

Yes

No

FEIN Number*

(e.g. xx-xxxxxxx)

Note: In the Attachments tab of this application, you will be asked to upload your organization’s letter from the Department of the Treasury, Internal Revenue Service, designating the organization as a tax-exempt organization. Failure to provide the requested documentation may result in the denial of your application for funding.

Description of the organization*

Please include mission, vision, purpose, and core values.

Brief history of the organization*

Name of the Executive Director or President

Organization Board of Directors

Identify board members on the executive committee by post

Name

Board Position

Organization Management Team*

Name

Role/Responsibility

Total number of full-time staff

Total number of part-time staff

Total number of volunteer staff

Is this the first time your organization is applying for a grant from the Alexander S. Pissios Family Foundation?*

Yes

No

Indicate if the applicant has received a grant from either of these organizations. (check all that apply)

Cinespace Chicago Film Studios

Cinecares Foundation

Stage 18

List any other grants the applicant has received in the past year, including, without limitation, federal, state, or private grants.*

Type ‘Have not received a grant’ and ‘0’ if have not received a grant in the past year

Name of Grant

Amount Received

If applicable, provide your organization's top five contributors/funders from the most recently completed fiscal year. Provide a list in this format: Funder Name/Type (Government, Corporate, Foundation, Board Member, etc.) Amount/Date (Month & Year) received.

Name of Funder

Funder Type

Amount Received

Month/Year Received

Calculated Annual Revenue in the previous fiscal year (in dollars)*

Provide your organization’s calculated Annual Revenue for FY23. To calculate Annual Revenue, refer to your organization’s total annual revenue, subtracting any government funding (including federal, state, or municipal) or in-kind contributions received.

Note: in the Attachments tab of this application, you will be asked to upload financial statements.

Annual Revenue (based on the last three years)*

Note: in the Attachments tab of this application, you will be asked to upload financial statements.

Describe any partnerships or collaborations that are key to your organization.

Describe how the organization aligns with the Alexanders S. Pissios Family Foundation funding priorities.*

Funding local non-profit organizations that provide education and workforce development for young adults with special needs that lead to self-sustaining job opportunities.

Funding local, national, and international non-profit organizations that provide programs to strengthen the relationship between Greece and the United States and develop, enhance, and preserve Greek culture, education, and language.

Funding local non-profit organizations that provide sustainable employment opportunities to women-led single-parent households so that these parents and families can become self-reliant and prosper.

Is your organization led explicitly by, for, and about any of the following populations:

American Indian/Alaskan Native

Asian

Black/African-American

Hispanic/Latino/a/x/e

Middle Eastern or North African

Native Hawaiian/Pacific Islander

Multi-Racial

Other

Population Benefited by the Organization by Race/Ethnicity. Check any group estimated to reflect 25% or more of the population benefited.*

Select up to 4.

American Indian/Alaskan Native

Asian

Black/African-American

Hispanic/Latino/a/x/e

Middle Eastern or North African

Native Hawaiian/Pacific Islander

White

No single racial/ethnic group made up more than 25% of the population directly benefited

Population Benefited by the Organization by Age. Check any group estimated to reflect 25% or more of the population benefited.*

Select up to 4.

Children/Youth (0–18 years)

Young Adults (19–24 years)

Adults (25–64 years)

Older Adults (65+ years)

No single age group made up more than 25% of the population directly benefited

Population Benefited by the Organization by Distinct Groups. Check any group estimated to reflect 25% or more of the population benefited.*

Select up to 4.

Families

Immigrants/New arrivals in the US

Individuals with Disabilities

Individuals in Institutions (e.g., nursing homes, hospitals, homeless shelters)

Individuals below the Poverty Line

Individuals who are Currently or Formerly Incarcerated/Returning Citizens

Individuals experiencing Homelessness

Individuals with Limited English Proficiency

LGBTQIA+

Military Veterans/Active-Duty Personnel

Youth at Risk

No single distinct group made up more than 25% of the population directly benefitted

About the Program

Amount Requested (in dollars)*

Maximum $10,000

Please enter a number less than or equal to 10000.

Projected Program Budget*

Projected Program Expenses*

Purpose of the Program*

Check all that apply

Raise awareness

Raise money

Provide services

Provide resources

Provide training

Add services to another program

Community Relations/Community Outreach

Advocacy for policy, regulation or investment

Other

Describe how the Program will benefit the organization, including the impact on the organization if the funding goal for the program is not met.*

Program date: is the Program offered:*

Throughout the year

Seasonally

Monthly

Weekly

Periodically

Is the Program available in-person, online/virtual, or both?*

In-person

Online/Virtual

Both

What is the number of people anticipated to participate in the Program?*

Estimate the number of in-person and online/virtual.

How will the Program be promoted?*

Check all that apply

Email

Direct Mail

Social Media Posts

Social Media Advertising

TV or Radio Advertising

Media Relations

Other

Population Benefited by the Program by Distinct Groups Race/Ethnicity.*

Check any group estimated to be 25% or more of the population benefited.

American Indian/Alaska Native

Asian

Black/African-American

Hispanic/Latino/a/x/e

Middle Eastern or North African

Native Hawaiian/Pacific Islander

White

No single racial/ethnic group made up more than 25% of the population directly benefited

Population Benefited by the Program by Age.*

Check all that apply.

Children/Youth (0–18 years)

Young Adults (19–24 years)

Adults (25–64 years)

Older Adults (65+ years)

Population Benefited by the Program by Distinct Groups.*

Check any group estimated to be 25% or more of the population benefited.

Families

Immigrants/New arrivals in the US

Individuals with Disabilities

Individuals in Institutions (e.g., nursing homes, hospitals, homeless shelters)

Individuals below the Poverty Line

Individuals who are Currently or Formerly Incarcerated/Returning Citizens

Individuals experiencing Homelessness

Individuals with Limited English Proficiency

LGBTQIA+

Military Veterans/Active-Duty Personnel

Youth at Risk

No single distinct group made up more than 25% of the population directly benefited

Additional Information about the population served by the Program

Provide any other distinctive information about the population served by your event that you would like us to know.

Accessibility Plans*

What accessibility plans does your organization have in place? What steps does/will your organization take to communicate and remove barriers to accessibility for people with disabilities, including individuals with visual impairments, mobility impairments, and/or speech impairments, individuals who are deaf and hard of hearing, and individuals with intellectual disabilities?

Attachments

The following materials MUST be in PDF format. If you do not have PDF documents, please refer to your word processing program for directions on how to create one. Failure to provide the requested documentation may result in the denial of your application for funding.

The most widely used programs, such as Microsoft Word, Google Docs, and Apple Pages, can create PDFs using these instructions. To create a PDF:

Open the file you wish to convert to a PDF
Click the File button
Select Save As
Select PDF
Choose where you want to save it

Proof of 501(c)(3) status*

Submit the most current FIRST PAGE of the letter from the Department of the Treasury, Internal Revenue Service, designating your organization as a tax-exempt organization.

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Current Illinois Charitable Organization Registration Statement (Form CO-1)*

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Most recent Form 990 or 990-N filed by the applicant with the IRS, including Schedule A, or an explanation of why none has yet to be filed

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Most recent and complete audited financial statements if available

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Board of Directors*

Please list your organization’s current Board of Directors and their outside affiliations or titles. Include their current roles in your organization where applicable.

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Board and Staff Demographics*

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Financial Statements*

Please submit financial statements from the most recently completed fiscal year.

Organizational budget of less than $300,000: Please submit a copy of your Federal Form 990, 990EZ, or 990N e-Postcard

Organizational Budget over $300,000: Please submit Federal Form 990 or your audited financial statements.

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

If your financial statements are from the prior year, or if you are submitting your 990N e-Postcard, Please also submit a year-end actuals statement OR A copy of State Form AG990 for the prior year.

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

FY23 Actuals Report

ONLY NEEDED from organizations unable to submit a Form 990 or Audit from the prior year. This information can be submitted in whatever format you use for your financial statements.

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Projected Organizational Budget for the Current year*

Upload your organization’s budget for the current fiscal year.

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Statement of Need

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Examples of stewardship PR

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 1.

Statement of Assurances

THE APPLICANT HEREBY AGREES THAT:

The activities and services for which assistance is sought will be administered by or under the supervision of the applicant.
Any funds received under this grant shall not be used to supplant funds generally budgeted for services of the same type.
The facts, figures, and representations made in this application, including all attachments, are true and correct to the best of the applicant’s knowledge and belief.
If the applicant is an organization, the organization’s governing board has authorized the filing of this application.
Applicant will expend funds received as a result of this application solely on the described projects and programs and, in the case of an organization, will separately provide funds for the organization’s maintenance.

THIS ASSURANCE is given in consideration of obtaining Alexander S. Pissios Family Foundation grants, contracts, or other financial assistance extended after the date hereof, including payments after such date regarding assistance committed before such date. Applicant agrees that such assistance will be extended in reliance on this Assurance and that the government agency operating under Acts cited above shall have the right to seek judicial enforcement of this Assurance. This Assurance is binding on the applicant, its successors, transferees, and assignees. The person or persons whose signature appears below is authorized to sign this Assurance on behalf of the applicant.

Certification and Release

The undersigned certifies that he or she (1) is an authorized signatory for the applicant; (2) has knowledge of the information presented herein; (3) has read the guidelines of the Alexander S. Pissios Family Foundation incorporated herein by reference, and that this applicant releases the Alexander S. PissiosFamily Foundation its employees and agents concerning damages to property or materials submitted in connection herewith.

Organization Name*

Applicant Signature*

Your initials will serve as an electronic signature.

Typed Name of Signatory*

Title of Signatory*

Date*

MM slash DD slash YYYY

Optional Survey

How many hours did it take you to complete this application?

Which part of the application was the most time-consuming?

Narrative Questions

Compiling Demographics/Information about Board and Personnel

Compiling Financials

Other

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Alexander S. Pissios Family Foundation is a 501(c)(3) non-profit organization registered in the state of Illinois.