ZZ Test JAS PRE-APP Organization Name(Required)Is this organization a U.S. 501(c)(3) entity, or tax-exempt under the laws of its local jurisdiction?(Required) Yes No Has this organization been in continuous operation for at least two years?(Required) Yes No Adventist Connection(Required)This organization is. . . Seventh-day Adventist publication Seventh-day Adventist university or academy Independent organization supporting or reporting on issues affecting the Seventh-day Adventist Church None of these 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 Contact Name(Required) First Last Email(Required) Enter Email Confirm Email CAPTCHAPlease check our eligibility requirements. TESTING CONTEXT ONLY Step 1 of 7 14% EmailThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formProject Funded? Yes No This field is hidden when viewing the formGrant YearOrganization Name(Required)Is your organization based in the United States? Yes No 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 Does your Organization have a website?(Required) Yes No Website(Required) Is your organization headquartered in North America?(Required) Yes No Contact PersonName(Required) First Last My Role in the Organization(Required)Phone(Required)Phone(Required)Extension (Optional)Email(Required) Enter Email Confirm Email If a pre-form is required, this would be the only thing on this screen.CLICK HERE to start your application. Versacare Foundastion's JAS grant funds projects that address the following needs. Please check all items below that apply to your grant request(Required)Check all that apply. Systemic issues that demand investigation and fresh thinking Journalists and media organizations producing major stories on vital issues New ways to communicate the diverse stories of what God is doing Awards and recognition to celebrate journalistic achievements and foster a culture of excellence in ethical storytelling Evaluation methods to maintain accountability and ethics Courses, workshops, and mentorship programs to enhance journalist skills, ethics, and innovative practices Issues similar to the above, but unidentified Choose which best describes your organization.(Required) Seventh-day Adventist General Conference, Division, Union, or Conference publication Seventh-day Adventist denomination owned or sponsored Academy Seventh-day Adventist denomination owned or sponsored University Independent organization supporting or reporting on issues affecting the Seventh-day Adventist church OTHER Other:Does your organization publish a weekly, monthly, or quarterly periodical?(Required) Yes No Periodical Name(Required)Frequency of Publication(Required)WeeklyMonthlyQuarterlyCirculation(Required) 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 SITEWhat year was your organization established?(Required)Please enter a number from 1763 to 2099.Has your organization been in continuous operation for the past two years?(Required) Yes No Using formatted text (i.e. bullets, bold, or italics) will increase your character count. Briefly describe your organization’s history and purpose:(Required)If your organization has a mission statement, please enter it here.Credentials, Accreditations, Affiliations(Required)List any credentials, accreditations or affiliations your organization has.Board Members(Required)Attach a list of your organization’s current board membersAccepted file types: doc, docx, pdf, Max. file size: 39 MB. Financial Statements(Required)Attach your most recent annual financial statement (balance sheet, income and expenses statement) A copy of your bank statement is insufficient. Your application will be evaluated based financials covering 12 months of operation.Accepted file types: pdf, xls, xlsx, Max. file size: 39 MB. Project Name(Required)For example, "Journalism workshops" or "Investigative story." Please do not include your organization name in this field.Purpose of Grant(Required)Explain the purpose of this grant--what issue or opportunity will it address?If you do not have all the required documents, you may either 1) upload a placeholder file, or 2) click the SAVE AND CONTINUE button at the bottom. You will then receive an email link that allows you to come back and complete your application later.Proposal Budget(Required)Please attach the budget for this grant request. See a sampleAccepted file types: pdf, xls, xlsx, Max. file size: 39 MB. Grant Request Amount(Required) $5,000 $7,500 $10,000 $12,500 $15,000 19. Project CostsList your project costs: itemize what you expect to spend to complete the project. 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 DescriptionLine Item DescriptionLine Item DescriptionLine Item DescriptionLine Item DescriptionLine Item DescriptionLine Item DescriptionTOTAL BUDGET(Required) 20. Project Income List your project income from all sources, NOT including the proposed Versafund grant.Line ItemDescriptionLine ItemDescriptionLine ItemDescriptionLine ItemDescriptionLine ItemDescriptionLine ItemDescriptionLine ItemDescriptionLine ItemDescriptionLine ItemDescriptionLine ItemDescriptionTOTAL INCOME Using formatted text (i.e. bullets, bold, or italics) will increase your character count. Project Activities(Required)Describe what you will do, who will be involved, and how it will be implemented.Timeline(Required)Outline the projected sequence of events and their time frames.Previous Work(Required)Describe any prior work or research that informs this project.Goals & Anticipated Outcomes(Required)What do you hope to achieve? How will you measure success and impact?Recognition (optional)Include links to relevant press coverage, online features, or recognition of your previous team, work or organization. Additional Files (optional)Please 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. Signature(Required)I certify that the information provided in this application is true and correct, to the best of my knowledge.
