Application Versafund Grant Program Application Form Step 1 of 12 8% CLICK HERE to start your application. IMPORTANT NOTICE The link you received in your invitation email takes you to a NEW APPLICATION. If you do not complete your application in one sitting, please do not click that link again. Instead, please use the SAVE AND CONTINUE LATER button at the bottom of any page. That will email you a different link that allows you to return to your partially completed application.1. Organization Name(Required) 2. Organization Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 3. Does your Organization have a website?(Required) Yes No 3a. Website(Required) Contact Person4. Name(Required) First Last 5. My Role in the Organization(Required) 6. Phone(Required) 6. Phone(Required)6a. Extension (Optional) 7. Email(Required) Enter Email Confirm Email 8. Versacare Foundation prioritizes funding projects in North America, Central America, Caribbean Islands, Colombia, Venezuela and Micronesia. Is your project located or doing work in one of these geographic regions?(Required) Yes No 8a. Project Location(Required) City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 9. Versacare Foundation funds projects that address the following needs. Please check the box or boxes that apply to your grant request:(Required) Church community engagement Disadvantaged or underserved communities Education and science education Health and wellness Humanitarian efforts Social justice Women’s and children’s efforts Youth and young adults Other – not on this list Other(Required) 9b. Did you attend a Versacare Foundation sponsored pastor cohort studying community engagement?(Required) Yes No Please initial each of the following:I understand that Versacare Foundation’s goal is to fund my ministry effort for three funding cycles, however I understand and agree that any funding is subject to my completing the application process and subject to Versacare Foundation Board approval.(Required) I understand and agree that before I can qualify for funding in year two, I will need to conduct an objective SWOT or similar analysis of my funded project and provide it to Versacare Foundation before the application deadline.(Required) I understand and agree that funding in year three is dependent on (1) my conducting an objective SWOT or similar analysis of my funded project and providing it to Versacare Foundation before the application deadline, and (2) my ministry developing and obtaining commitments from outside partners before the application deadline.(Required) 10. Is your organization a congregation, school or other entity owned or operated by a Seventh-day Adventist Conference, Union, North American Division, or Inter-American Division or General Conference?(Required) Yes No 10a. Is your organization a primary or secondary school operated by an Adventist Conference or congregation?(Required) Yes No 10b. If yes, is your school applying for a STEM grant?(Required) Yes No 10c. How many classrooms does your school have?(Required)Please enter a number from 1 to 99.10d. What is your school's present enrollment?(Required)Please enter a number from 1 to 9999.10e. Has your school received a Versacare Foundation STEM grant in the past?(Required) Yes No 10f. Please provide the most recent year your school received a Versacare Foundation STEM grant.(Required)Please enter a number from 1980 to 2050.10g. Please attach a copy of your school board approved technology plan for the next school year.(Required)Max. file size: 39 MB.10a. If no, please state your organization’s affiliation with the Adventist church.(Required)10b. Is your organization a 501(c)(3) tax-exempt entity?(Required) Yes No 10c. If yes, please provide your Federal Tax Identification Number (EIN).(Required)Federal Tax Identification Numbers are public record. If your organization has one, you can look it up at THIS SITE 10d. Is your organization a tax-exempt entity under the laws of your local jurisdiction?(Required) Yes No 10e. If yes, please provide proof of your tax-exempt status.(Required) Drop files here or Select files Accepted file types: pdf, Max. file size: 39 MB. 11. What year was your organization established?(Required)Please enter a number from 1763 to 2022.12. Has your organization been in continuous operation for the past two years?(Required) Yes No We’re sorry. . . Your organization may not be considered for a Versafund grant at this time. Please contact us if you have any questions. We’re sorry. . . Your organization may not be considered for a Versafund grant at this time. Please contact us if you have any questions. 13. Briefly describe your organization’s history and purpose:(Required)14. List any credentials, accreditations or affiliations your organization belongs to:(Required)15. Matching or other funds from sources outside your organization are encouraged as one way to extend any funds Versacare Foundation might award to your project. Are there matching or other funds from sources outside your organization for your project:(Required) Yes No 15a. Please identify the source(s) and amount(s) of any additional funding.(Required)Click the PLUS (+) sign at the right to add a new row.AmountSource Add Remove16. If your request is funded, do you agree to provide a full financial accounting of how Versafund monies were used and agree to be audited if requested?(Required) Yes No 17. Which grant are you applying for?(Required)If you wish to apply for an Impact grant, please see THIS PAGE. Catalyst – $2,500 to $10,000 Venture – $10,001 to $40,000 HiddenImpact We’re sorry. . . Your organization may not be considered for a Versafund grant at this time. Please contact us if you have any questions. Because of their significance, applications for Impact grants are pre-screened. Please complete the form at the bottom of this page to request an invitation.If you are invited to complete an application, you will be provided with a link that will allow you to complete the process. Catalyst: $2,500 – $10,000Venture: $10,001 – $40,000Impact: $40,001 – $100,000If you do not have all the required documents, please click the SAVE AND CONTINUE button at the bottom. You will receive an email link that allows you to come back and complete your application later.C1. Attach a list of your organization’s current board members(Required)Accepted file types: doc, docx, pdf, Max. file size: 39 MB.C2. Attach a copy of your most recent annual financial statement(Required)Accepted file types: pdf, xls, xlsx, Max. file size: 39 MB.C3. Describe the project or program for which you are requesting funding(Required)C4. Describe the activities of the project or program for which you are requesting funding(Required)C5. Identify the project or program beneficiaries(Required)C6. Describe your previous work with these beneficiaries, if any(Required)C7. Identify any disadvantaged or underserved groups among your project beneficiaries(Required) V7. If your project targets disadvantaged or underserved groups, describe how the project will benefit those communities.(Required)V8. Share past performance outcomes of your project or program. This is different from past performance outputs (activities), which you reported above.(Required)V9. Provide evidence or research supporting your project’s goals and objectives(Required)V10. Describe your proposed performance measurement for this project, including a timeline of when the performance measurement review will take place during the funding year(Required)V11. Does your organization have partners or collaborators?(Required) Yes No V11a. List your partners or collaborators with a brief summary of the role of each as it relates to the project or your organization.(Required)PartnerRole Add RemoveV11b. Do you have a proposal for how partners or collaborators might be added during the funding year?(Required) Yes No V11c. Please describe how you propose to add partners during the funding year(Required) List your project costs. If necessary, group expenses by category so that there are no more than ten items.Line Item(Required) Description(Required) Line Item(Required) Description(Required) Line Item(Required) Description(Required) Line Item Description Line Item Description Line Item Description Line Item Description Line Item Description Line Item Description Line Item Description TOTAL BUDGET(Required) List your project income from all sources, including the proposed Versafund grant.Line ItemDescription Line ItemDescription Line ItemDescription Line ItemDescription Line ItemDescription Line ItemDescription Line ItemDescription Line ItemDescription Line ItemDescription Line ItemDescription TOTAL INCOME C10. Please provide links to online coverage or mention of your organization, of your project, or of your project administrators(Required)Additional FilesPlease upload any additional documents that may help us evaluate your application. Drop files here or Select files Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 39 MB, Max. files: 5. CATALYST Grant request amount(Required)Please enter a number from 2500 to 10000.VENTURE Grant request amount(Required)Please enter a number from 10001 to 40000.IMPACT Grant request amount(Required)Please enter a number from 40001 to 100000.C11. Would you be able to carry out this project if your request is partially funded?(Required) Yes No C11a. How would you use these funds if your request is partially funded?(Required)Include the minimum amount needed to carry out this project.C12. If your project gets funded at this time, how will it be funded in the future?(Required)Include the minimum amount needed to carry out this project.PhoneThis field is for validation purposes and should be left unchanged. You may need to click PREVIOUS or NEXT to make sure your work is saved before clicking SAVE & CONTINUE.
