New Mexico Office of African American Affairs
Request for Funding Proposal
All requests should align with the mission of the New Mexico Office of African American
Affairs which is to study, identify, and provide solutions to issues of concern relevant to the
African American community.
AWARDS
All awards are contingent upon appropriations and funding availability. All information
submitted will be reviewed by the Executive Advisory Committee to establish funding. The
maximum amount of approved awards may not exceed $2,000. If there is a desire for increased
funding for program delivery, contractual service agreements would need to be discussed with
the Executive Director.
Please Note:
***Incomplete proposals will not be considered.
***The New Mexico Office of African American Affairs must be listed as a sponsor on all
marketing material in order to receive funding.
***Due to state procurement codes, all funding is processed on a reimbursement basis ONLY.
***Funding will not cover food or travel expenses.
*Check One
� Program or event supports one or more of the New Mexico Office of African American
Affairs five focus areas: (*Circle All That Apply)
Advocacy and Policy
Educational Advancement
Economic Empowerment
Health Care
Community Development
� Juneteenth Programming
Today’s Date: _______________________
Date of Event: ______________
Name of Organization/Program: ___________________________________________________
Address: ___________________________ City: ___________ State: NM
Zip: __________
Contact Name: ______________________ Phone Number: ____________________________
Email: _____________________________
Amount Requested from OAAA
$ _______________
Request for funding must be turned in for review at least two months in advance of event date.
Revised 3/3/2015
POPULATION SERVED
(demographics – indicate how many individuals served in each category; if applying for event
funding enter prior year attendance data)
Ages: ___ 0-5
___46-55
___ 6-11
___56-65
___12-15
___ 66-75
Socio Economics: _____% Low-Income
Gender: ____% female
___19-25
___26-35
___86-100+
___36-45
_____% Middle-Income _____% Higher Income
____% male
Race/Ethnicity:
___% African American
___% Native American
___16-18
___76-85
___% Caucasian
___% Hispanic/Latino
___% Asian
___% Other
*Please Type or Print responses to the following on separate paper and submit with this Proposal
ORGANIZATION AND MISSION
Give a brief history of your organization or program. Make sure to include establishment date,
mission, organization/program goals, history of service outcomes (number of individuals served,
economic impact, major successes, etc…), program/event curriculum structure, and which New
Mexico communities are impacted.
(Max 200 words)
COMMUNITY NEED
Define the area of disparity addressing target audience, proof of need (statistics for your community),
and expected outcomes.
(Max 100 words)
PROGRAM/EVENT OBJECTIVES
Name who, what, when, where, and how the funding will assist your organization’s impact on
achieving program/event objectives. Be sure to include the number of individuals whom will
benefit from the program/event.
(Max 100 words)
OUTCOMES AND EVALUATION
How will you measure the outcomes of the program/event to ensure objectives were met? Make
sure they are measurable (pre-post survey, attendance records, improvement of collaborations and
partners, increase in volunteer hours, economic impact, etc…..).
(Max 50 words)
SUSTAINABILITY OF PROJECT
How will you insure that the program/event has a lasting, sustainable impact in the community?
(Max 50 words)
PUBLICITY
How will you insure that the program/event is publicized for maximum attendance and has the
acknowledgment of the New Mexico Office of African American Affairs as co-sponsor?
(Max 50 words)
Revised 3/3/2015
GOODS AND SERVICES
List goods or services to be reimbursed with funding support from the New Mexico Office of African
American Affairs. Note: Funding may not be reimbursed for certain categories (i.e., food, travel,
and salaries). Only validated itemized receipts must be submitted for reimbursement – no written
receipts will be accepted in lieu of originals.
PARTNERS/REVENUE
What community organizations, businesses, advocacy groups, etc., have you partnered with to
accomplish other sources of funding? Is there any revenue coming from this event: auction, banquet,
personal contributions etc.? Please list source and amount.
OTHER SOURCES OF FUNDING
AMOUNT
$
Total
$
BUDGET INFORMATION
What expenses are related to Program/Event? Please list expenses, amount, and justification.
LIST EXPENSES
JUSTIFICATION
AMOUNT
$
Total
$
Total Cost of Program/Event: ____________________________
VERIFICATION
Have you ever received funding from OAAA or any other State Agency? Yes/No _____
If so what agency? ______________
Vendor #______________ or attach a State-Substitute W-9 or Federal W-9
Revised 3/3/2015
CERTIFICATION
I certify that all information submitted in proposal is complete and is a true representation of all
program/event services, objectives, outcomes, budget, and purpose of funding support.
I also authorize the New Mexico Office of African American Affairs to utilize program information
for public record, including but not limited to publicizing and reporting.
I further understand that all awards are given on a reimbursement basis (after all duties have been
performed or completed) and are subject to eligibility of approval (information in proposal must
be complete and concise). All funding awards are contingent based on available appropriations.
Signature: ____________________________
Date: ___________________
Printed Name: _________________________
Return completed Proposal Information to:
Attn: Budget Analyst
New Mexico Office of African American Affairs
1015 Tijeras NW, Suite 102
Albuquerque, NM 87102
Email: tanyam.ramirez@state.nm.us
Fax: (505) 222-9489
Phone: (505) 222-9405
_________________________________________________________________________________
Agency Use Only
This Funding Request for $_______________ has been approved in the amount of $_____________
Revised 3/3/2015