Grant Concept Paper Alcoa Foundation is excited to learn about your organization and the program or initiative for which you are requesting a charitable grant from Alcoa Foundation. In order to conduct a comprehensive review of your organization’s eligibility to receive a charitable grant and of the alignment of the program with Alcoa Foundation’s focus areas and results metrics, this Grant Concept Paper must be completed in its entirety and signed by an authorized official. The submission of this Grant Concept Paper does not guarantee a grant from either Alcoa Inc. or Alcoa Foundation. If Alcoa Foundation decides to pursue this partnership with your organization, you will receive an invitation to submit a formal on-line application. Much of the information provided in this Grant Concept Paper can be copied and pasted into the online application. At the time a formal grant application is submitted to Alcoa Foundation, you will be required to attest to a non-discrimination statement declaring that your organization does not discriminate based on race, color, religion, national origin, disability, sexual orientation, gender identity/expression, veteran status, genetic information, sex or age (within statutory limits) or on any other legally prohibited basis. General Grantee Information 1. Organization Name Contact Name Contact Title Full Mailing Address E-mail Address Phone #: 2. Type of organization nongovernmental – nonprofit agency government-owned or –operated hospital government agency private, nongovernment-owned or –operated government-owned or -operated school – hospital primary, secondary or post-secondary other Short description private, nongovernment-owned or –operated school - primary, secondary or postsecondary 3. What are your organization’s mission and vision? Guidance: Mission is what you do; vision is the end state you wish to achieve. Great mission and vision statements are short, but clear. Describe how your mission gives you focus and guides your actions and decisions. Mission: Vision: 4. In what countries does your organization operate? 1 rev. 3/12/2013 Grant Concept Paper General Grantee Information 5. If it operates in several countries, in which countries would Alcoa Foundation grant funds be used? 6. How long has your organization been operating in the countries in which the grant funds will be used? 7. What was your organization’s total annual operating revenue for your most recently completed fiscal year? USD 8. What was the total amount of charitable contributions received by your organization during your most recently completed fiscal year? USD How many grants/contributions does this represent? 9. Has your organization ever received a charitable grant from Alcoa Foundation? If so, in what year? and for how much? USD 10. Does your organization partner with any other large U.S. companies? If so, please identify them. Yes Yes No No 11. What is the name of the national authority which governs the registration of charities/nonprofits in your country? 12. What is your organization’s registration number as assigned by this authority? 13. If you cannot provide the information requested in questions 11 and 12 above, please explain why. 14. Is the following information about your organization available to the general public? Names of officers and directors By-laws Financial statements Yes No Yes No Yes No 15. If you answered No to any of the above, are you willing to provide the information to Alcoa Foundation? Yes No 16. What percent of your total annual expenses are directed to program/charitable expenses? % 17. What percent of your total annual expenses are directed to administrative expenses? % (These two numbers must equal 100%.) 18. Is your organization able to accept donations by either check, wire, or credit card? Yes 19. Is the organization which would receive these grant funds different from the organization which is submitting this Grant Concept Paper? Yes 2 No No rev. 3/12/2013 Grant Concept Paper Connections to the Government1 20. Did any government official or any person representing a government ask you to request a grant from Alcoa Foundation? 21. Does your organization have officers or directors who are either a) government officials or b) family members of government officials? If Yes, identify them by full name. 22. Are there financial, fiduciary, ownership, or other relationships between your organization and any government or government official? Yes No Yes No Yes No Grant Information 23. What is the grant amount requested from Alcoa Foundation? USD 24. What is the total budget for the project for which funding is requested? payable over years USD 25. Project Start Date Guidance: Enter the date on which you expect to begin using the grant funds and begin working towards the project results described in this application. 26. Project End Date Guidance: Enter the date by which you expect to achieve the project results described in this application. All grant funds must be expended by this date as well. We are interested in results that can be achieved within a 12-month period, but are open to programs and projects that may require a shorter or longer time period for the results to be achieved. 27. Are reporting requirements up to date for all previous Alcoa Foundation grants? Yes No 28. What community issue does this initiative address? Describe the target group and the challenge or opportunity to be addressed? 29. Who will benefit from this initiative and how many? You will be required to report interim and final results against these projections. people communities organizations 30. Provide a brief description of the project for which you seek support, including the overall goal of the project, use of Alcoa Foundation funds, total anticipated number of people or places to be served and geography served by the project. Limit your description to no more than five sentences. 1 For these purposes, “government” refers to all governments, whether local, provincial, or national; any agency thereof; or any enterprise or other entity that is wholly or partially owned or controlled by a government. “Government officials” are persons who work for any “government.” 3 rev. 3/12/2013 Grant Concept Paper 31. In the dropdown box below, select the Alcoa Foundation result to which this project clearly contributes. Before making a selection, refer to the Alcoa Foundation Grant Guidelines. Environment/Reduce 32. In the Alcoa Foundation Grant Guidelines there are specific metrics for each result area. They are under the heading “Results we will count.” What is/are the metrics you intend to count if this grant is approved? You may enter more than one metric. You will be required to report on the results in a final grant report. Metric (refer to the Alcoa Foundation Grant Guidelines) # you expect to achieve 33. What are the specific, measurable results you expect to achieve for those you intend to serve, and by when would these results be achieved? Limit your response to no more than three (3) sentences. You will be required to provide interim and final reports on these results. Your answer to this question must include the components shown in the example below, which are: a) the measureable results you expect to be achieved as a direct result of a grant from Alcoa Foundation, b) the date by which you expect those results to be achieved, and c) the individuals, organizations or communities you expect to achieve the results. Guidance: Results are the changes in the behaviors or conditions of your participants, organization or the system itself as a result of interacting with your project or program. Do not focus on activities, projects implemented or levels of participant satisfaction. Focus instead on how participants will be different after they complete their interaction with you. Example: By (project end date), at least XX of the expected XXX participants will (state the measurable result you expect them to achieve). 34. How will you know when this initiative's results have been achieved? What information or evidence will be used to verify success? 35. Identify other committed funders for this program and include the amount of their commitment during the grant period described in this application. 36. What is your communications strategy for this project? Guidance: a) Be specific and include detail such as press releases, web postings, brochures or other related material , and b) Identify the types of media you plan to use (if any), and approximately how many articles/reports you expect in each category 4 rev. 3/12/2013 Grant Concept Paper 37. If applicable, what opportunities are there for volunteer engagement? Guidance: Categories of volunteers might include: Alcoa employees, Alcoa retirees, students and community members. Sample volunteer options include: manual volunteerism, skills-based volunteerism, volunteer keynote speaker, volunteer panelist, board placement, knowledge sharing, etc. Volunteer opportunities are encouraged, but not required for a grant. I certify that the above information is complete and accurate to the best of my knowledge and that I am authorized to provide this information and request a grant from Alcoa Foundation on behalf of the organization named in Question 1. I understand that the submission of this Grant Concept Paper does not guarantee a charitable grant from either Alcoa Inc. or Alcoa Foundation. Signature Date Typed Name Title 5 rev. 3/12/2013