Preview Form
This is an example of the application questions with which you will be presented. It is recommended that you
compose the answers to the paragraph questions in a word processing program and then cut and paste that
text into the online application.
Contact Information
Select the names below who are contacts for this grant application and/or add any new
contact(s).
Title
(Text)(500 character maximum)
Instructions:
*Prefix
(Single-Select List)
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Dr.
Miss
Mr.
Mrs.
Ms.
Professor
The Honorable
Instructions:
*First Name
(Text)(40 character maximum)
Instructions:
 First Name
*Last Name
(Text)(40 character maximum)
Instructions:
 Last Name
*Street Address
(Text)(100 character maximum)
Instructions:
 Address
Address 2
(Text)(500 character maximum)
Instructions:
*City
(Text)(50 character maximum)
Instructions:
 City
*State or Province
(Single-Select List)
Instructions:
*Postal Code
(Text)(20 character maximum)
Instructions:
 Please provide the full 9-digit zip code
*Telephone
(Text)(30 character maximum)
Instructions:
 Telephone
Extension
(Text)(500 character maximum)
Instructions:
*E-mail Address
(Text)(100 character maximum)
Instructions:
 E-mail Address
Organization Information
*Legal Name
Instructions:
(Text)(255 character maximum)
*Street Address
(Text)(100 character maximum)
Instructions:
Address 2
(Text)(100 character maximum)
Instructions:
*City
(Text)(50 character maximum)
Instructions:
*State
(Single-Select List)
Instructions:
*Postal Code
(Text)(20 character maximum)
Instructions:
 Please provide the full 9-digit zip code.
Tax ID
(Text)(10 character maximum)
Instructions:
 Please enter 9-digit number.
Canadian Charity Registration Number
(Text)(15 character maximum)
Instructions:
 Please enter the 15-character number (9 numbers,
the letters 'RR', followed by 4 more numbers).
*Phone Number
(Text)(30 character maximum)
Instructions:
 Please enter main phone number.
Fax Number
(Text)(30 character maximum)
Instructions:
 Please enter main fax number.
*E-mail Address
(Text)(100 character maximum)
Instructions:
 Please enter main e-mail address.
Website Address
(Text)(100 character maximum)
Instructions:
 Please enter the organization's website address.
Social Media Website Address(es)
(Text)(200 character maximum)
Instructions:
 Please enter any social media URL links.
Proposal Information
*Program Title
(Text)(255 character maximum)
Instructions:
*Requested Amount
(Currency)(20 character maximum)
Instructions:
 Only proposals requesting from $25,000 to
$100,000 will be evaluated
*Number of Participants Directly Involved
(Text)(15 character maximum)
Instructions:
 Number of Participants Directly Involved
*Geographical Area Served
(Single-Select List)
Instructions:
 What one geographic area will benefit most from
this project?
General Geographic Area
(Single-Select List)
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Local Community
Multi-State
National
Regional Area
Instructions:
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School
State
*Schools or School Districts Impacted
(User-Defined List)
Demographics
Instructions:
 Please list any schools or school districts impacted
by this grant. (If more than one school is involved in
the project, then list all that apply.)
Instructions:

(No input required)
Completion of the following section is
voluntary. Information provided will not be
considered for the purposes of grant
selection. If you prefer not to respond,
please enter 100% in 'No Response'.
*Ethnicity Served
(Percentage List)
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No Response
American Indian \ Alaska Native
Asian
Black \ African American
Hispanic \ Latino
Native Hawaiian \ Other Pacific Islander
White
Not Specific
Instructions:
 Please provide the percentage for each ethnicity
served by the project. All percentages must add up to
100%.
*Age Group Served
(Percentage List)
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No Response
0-4 yrs Infants \ Toddlers
5-12 yrs Children
13-20 yrs Teens \ Young Adults
21-29 yrs
30-64 yrs
65+ yrs Seniors
All Ages
Instructions:
 Please provide the percentage for each ethnicity
served by the project. All percentages must add up to
100%.
*Gender Served
(Percentage List)
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No Response
All
Females only
Males only
Instructions:
 Please provide the percentage for each ethnicity
served by the project. All percentages must add up to
100%.
*Population Served
(Percentage List)
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No Response
All Populations
Low Income
Moderate Income
Middle Income
High Income
Instructions:
 Please provide the percentage for each ethnicity
served by the project. All percentages must add up to
100%.
Investigation
*Please give us a brief summary of your project.
(Paragraph)(2000 character maximum)
Instructions:
 Please provide a summary of the project.
*How does this project qualify as service
learning?
(Paragraph)(900 character maximum)
Instructions:
 How does this project qualify as service-learning?
How is the service performed in the community
connected to K-12 curriculum? If not using K-12
curriculum, please explain how this curriculum can
enrich student learning.
*What is the YAB issue area your project will
address?
(Single-Select List)
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Arts and Culture
Community Safety and Justice
Economic Empowerment and Financial
Literacy
Access to Higher Education / Closing the
Achievement Gap
Environmental Responsibility
Health and Wellness
Instructions:
 What is the YAB Issue area your project will
address?
*Previous Funding
(Yes/No)
Instructions:
 Have you received Youth Advisory Board funding
before for this project?
Additional Funding Justification
(Paragraph)(2000 character maximum)
Instructions:
 What has been the impact of that funding, and how
does this year’s program build upon last year’s
program to warrant additional funding?
*Please explain (providing statistics and
evidence) what unmet need in your community
your service-learning proposal addresses and
whom it benefits.
(Paragraph)(900 character maximum)
Instructions:
 How does it address the root cause of the
problem? What evidence demonstrates that your
project will be successful in addressing the issue?
*What is unique about your project?
(Paragraph)(900 character maximum)
Instructions:
 What is unique about the approach of your service
learning project? If your approach has been taken
before, please explain the prior impact of the
approach and how it could be improved.
Preparation
*How were youth involved in the writing of this
grant proposal?
(Paragraph)(600 character maximum)
Instructions:
 Were youth involved in writing the grant? If so,
how?
*How many young people, and in what ways, will
be involved in leadership roles in the planning
and execution of the project? How will youth be
trained and organized in order to be prepared for
their roles in the project?
(Paragraph)(900 character maximum)
Instructions:
 How many young people, and in what ways, will be
involved in leadership roles in the planning and
execution of the project? Please provide a specific
example of a young person taking a leadership role.
*Meaningful Service
(Paragraph)(900 character maximum)
Instructions:
 How will your project involve students in
meaningful service?
Execution
*Give a month-by-month overview of your
project's timeline. Please be specific.
(Paragraph)(900 character maximum)
Instructions:
 Please include what you aim to accomplish, when
you will accomplish it, and how you will accomplish it.
*Throughout the duration of your project, what
efforts will you be using to engage members of
your community?
(Paragraph)(900 character maximum)
Instructions:
 Will you be collaborating with other individuals,
businesses, or organizations for your project? Will
you engage other members of your community? If so,
how?
*How many young people will be impacted by the
project? How will this goal be measured?
(Paragraph)(900 character maximum)
Instructions:
 Please describe the metrics you will use to
evaluate the number of young people impacted by
this project.
*How will project awareness be generated
through traditional and social media outlets?
(Paragraph)(2000 character maximum)
Instructions:
 Please provide all social media handles with which
you will be promoting your project or the State Farm
Youth Advisory Board.
Reflection
*How will you evaluate the success of this
project?
(Paragraph)(450 character maximum)
Instructions:
 What opportunities will be provided for students
involved in the project to reflect on their service?
*How will your project remain sustainable after
the YAB Grant Period ends?
(Paragraph)(900 character maximum)
Instructions:
 How will your project remain sustainable after the
YAB grant period ends?
*How will your service-learning project impact
your entire community?
(Paragraph)(900 character maximum)
Instructions:
 How will your service-learning project impact your
entire community?
*Do you agree to provide State Farm semi-annual
and final results of this program?
(Yes/No)
Instructions:
 Do you agree to provide the State Farm Youth
Advisory Board monthly updates on the YAB website
about the progress of this project?
Additional Information
Extra Information
(Paragraph)(2000 character maximum)
Instructions:
 Here is a chance for you to include any additional
information that you did not already include in the
application but would like the State Farm Youth
Advisory Board to know.
How did you hear about the State Farm Youth
Advisory Board?
(Single-Select List)
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State Farm Agent
State Farm Employee
Non-profit organization
School/University
Statefarm.com website
YAB website
Other website
YAB member
Social Media
Press Release
Instructions:
 How did you hear about the State Farm Youth
Advisory Board?
*I confirm that the budget for this RFP does not
include the purchase or rental of vehicles, any
type of insurance, fringe benefits for employees,
indirect travel costs, or administrative costs that
are not directly related to the project.
(Yes/No)
Instructions:
*I confirm that the total salary does not exceed
20% of the total budget.
(Yes/No)
Instructions:
Budget
*Charitable Amount
(Currency)(15 character maximum)
Instructions:
 How much of the requested amount would be
considered a charitable donation? Enter dollar
amount. (Typically the YAB likes to see all 100% of
the grant considered a charitable donation.)
*Non-Charitable Amount
(Paragraph)(2000 character maximum)
Instructions:
 If the entire requested amount is not a charitable
donation, please list the value of incidental items or
benefits received by State Farm, if any. Please
provide dollar amounts and details.
Examples (not all-inclusive):
- Booth space at conferences/events
- Paid advertisements
- Travel allotments for SF YAB members
*Budget Upload
(File Upload)File Upload; 10485760 byte limit
Instructions:
 Please upload the Budget Excel File here. Click
here to download the YAB Grant Budget Template
Click on the link to open the file. Save it to your
computer, complete the fields, and then upload your
completed budget here.
Only a completed budget, using the included
template, will be accepted. No other
attachments will be considered when
reviewing your grant. You MUST include all
answers in the provided forms, additional
attachments will not be read.
*Salaries and Compensation
(Number)(15 character maximum)
Instructions:
 To help the YAB better examine the budgetary
requests of grantees, please enter the totals from
each category on the Excel budget file into the
application field below. (You will still need to attach
the complete Excel budget file in addition to these
totals.)
*Supplies and Equipment
(Number)(15 character maximum)
Instructions:
 To help the YAB better examine the budgetary
requests of grantees, please enter the totals from
each category on the Excel budget file into the
application field below. (You will still need to attach
the complete Excel budget file in addition to these
totals.)
*Travel and Lodging
(Number)(15 character maximum)
Instructions:
 To help the YAB better examine the budgetary
requests of grantees, please enter the totals from
each category on the Excel budget file into the
application field below. (You will still need to attach
the complete Excel budget file in addition to these
totals.)
*Promotion/Publicity/Marketing
(Number)(15 character maximum)
Instructions:
 To help the YAB better examine the budgetary
requests of grantees, please enter the totals from
each category on the Excel budget file into the
application field below. (You will still need to attach
the complete Excel budget file in addition to these
totals.)
*Expert Services
(Number)(15 character maximum)
Instructions:
 To help the YAB better examine the budgetary
requests of grantees, please enter the totals from
each category on the Excel budget file into the
application field below. (You will still need to attach
the complete Excel budget file in addition to these
totals.)
*Miscellaneous
(Number)(15 character maximum)
Instructions:
 To help the YAB better examine the budgetary
requests of grantees, please enter the totals from
each category on the Excel budget file into the
application field below. (You will still need to attach
the complete Excel budget file in addition to these
totals.)
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