PROVIDENT CASE DEVELOPMENT FORM
TITLE OF PROJECT/PROGRAM:
EXECUTIVE STATEMENT:
In 2-3 sentences, please describe the
project: What is the purpose? What will
you do? With whom? Where will it take
place? What makes the project
unique/most important?
How does your project align with the
goals of the organization?
What are key words that address your
project? (e.g. “at-risk youth”,
“communication disorders”, “restorative
justice”, etc.) This will help in
researching prospects.
Who will benefit from this project?
STATEMENT OF NEED:
Describe the specific issue that your
project will address. Why is it
necessary? How will this project change
current conditions?
GOALS & OBJECTIVES:
What specific changes do you expect to
make in the community or among the
beneficiaries as a result if this project?
What are your success indicators?
ACTION:
What steps will be taken to achieve
success for this project?
RESOURCES:
What resources do you need for this
project to be successful? (staff,
equipment, training materials, space
rentals, etc.)
EVALUATION:
How will you measure your success for
this project?
BUDGET:
Please list your total anticipated budget
need for this project (including
expenses, revenue, and anticipated
income).
Collaborative Partners:
Please list any collaborators and their
affiliated organizations.
The current situation is:
The three to five success indicators for our project or effort are:
$
What are possible funding sources you
might recommend as a fit for the
project?
(e.g. hospital systems, hotel chains, law
offices, foundations funding ‘at-risk’
youth, etc.)
Name your department:
Approval - Supervisor Signature:
Form prepared by:
Please list contact
information.
Name:
Signature:
VP Development & Marketing Only
Date:
Grants Manager Review: [ ] ________________________________
Follow-up appointment: [ ] ________________________________
Copy to Vice President for Development: [ ]
Copy to Supervisor: [ ]
Copy to Business Office: [ ]
Approvals needed:
Priority Level: [ ] High [ ] Medium [ ] Low