C A T E R P I L L A R
F O U N D A T I O N
U.S. Facility Grant Application
The Caterpillar Foundation provides program support in the areas of basic human needs,
environmental sustainability and access to education.
Please submit completed grant applications as an e-mail attachment and send to your local
contact with “Organization Name Grant Application” in the subject line.
ORGANIZATION INFORMATION
1. Tax ID Number:
2. Organization Legal Name:
AKA Name:
3. Address:
Mailing Address (If different from Street Address):
4. City:
5. State:
6. Postal Zip Code:
7. Telephone Number:
8. Fax Number:
9. Website Address:
10. Name of Executive Director:
11. Mission Statement/Principal Purpose of Organization:
12. Board Members - Please list in each of your Board Members and their affiliations:
13. Annual Report - Please include a copy of your most recent annual report and/or other
published description of the organization's activities as a web link:
14. Audited Financial Statements - Please include a copy of your organization's most recent
externally or internally audited financial statements as a web link e-mail attachment:
ORGANIZATION INFORMATION (cont.)
15. Current Fiscal Year End - Include current FYE budgeted revenue and expenses:
Current FYE Budgeted Revenue:
Current FYE Budgeted Expenses:
16. Prior Fiscal Year End - Include prior FYE revenue and expenses:
Prior FYE Revenue:
Prior FYE Expenses:
REQUEST INFORMATION
17. Request Date:
18. Amount Requested:
19. Program Title:
20. Program Start Date:
21. Program End Date:
22. Program Location - Where are your programs located? (e.g. Aurora, Illinois, USA):
23. Program Budget - Include all program expenses and revenues in U.S. dollars, including the
source of revenue and the amount:
24. Program Overview - Please describe the community need and how your program meets
that need:
25. Alignment to the Caterpillar Foundation mission - Explain how your program aligns with
the Caterpillar Foundation’s mission:
26. Recent Gifts - Please list the most recent gifts received from Caterpillar Inc., Caterpillar
Dealers, or the Caterpillar Foundation:
27. Caterpillar Employees - Please enter the name of any Caterpillar employee or retiree and
their involvement in this project:
DEMOGRAPHICS
28. People Served - Please include the number of people being served by this project:
29. Ethnic Groups Served - Please indicate the ethnic groups to be served by this project. Enter
whole numbers only, total must equal 100%:
Percentage %
100%
Ethnic Groups Served
African American
Asian/Pacific Islander
Caucasian
Hispanic
Native American
Other
Total Percentage
30. Age Groups Served - Please indicate the age group that your project will serve:
X
Age Groups Served
0-4 years (Preschool)
5/18 years (K-12)
18-25 years (Young Adults)
26-65 years (Adult)
65+ years (Mature Adult)
31. Gender Served - Please indicate the gender(s) being served by this project:
X
Gender
Female
Male
32. Income Group Served - Please select the income group served by your project:
X
Income Group Served
Under $20,000
$20,000 - $35,000
$35,001 - $50,000
$50,001 - $75,000
$75,001 - $100,000
Over $100,000
OUTCOMES / RESULTS OVERVIEW
33. Program Goals & Outcomes Overview:
Please use the table (next page) when describing your proposed outcomes. Feel free to add rows
to the table below with additional program goals.
We encourage you to utilize a format that includes specific, measurable, attainable,
realistic and timely goals and procedures to meet those goals when describing your
objectives.
How will your organization measure the effectiveness of activities and the expected results by end of the
funding period?
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Goal - What is the problem you are trying to solve? (e.g. Stop hunger and provide noon meal to
disadvantaged students.)
Activity - What are you doing to accomplish the goal? (e.g. Provide noon meal to disadvantaged
students.)
Outputs - Number & percentage of clients served (e.g. Survey shows 80% of all teachers feel their class
is more attentive. 75% of students show an increase in academic performance. School attendance
improved from 70% to 85% for all patrons.)
Outcomes - Clients’ change in knowledge of behavior (e.g. 500 people per day are no longer hungry,
and are able to improve their lives via job search, focusing in school, etc.)
Number of Beneficiaries – (e.g. 30 staff trained and educated, impacting 500 clients each day)
Measurement & Reporting Tools – How do you determine goal achievement? (e.g. Teacher surveys,
student academic evaluations, attendance records, pre and post-assessment surveys, weekly and
quarterly conversations with clients, etc.).
Evaluation Process - How often are the assessments? And what is the feedback process for staff? (e.g.
Teacher surveys, student academic evaluations, attendance records, pre and post-assessment surveys,
weekly and quarterly conversations with clients, etc.)
OUTCOMES / RESULTS
Organization Name: ABC Organization
Program Title: District School Feeding Program
Program Goal: Provide one nutritious meal per day to students
Activity
Outputs
Outcomes
Number of
Beneficiaries
Provide nutritious
20,000
Survey shows 80% of
60
noon meal to
meals
teachers demonstrate disadvantaged
disadvantaged
served
their class is more
children ages
students
during
attentive.
5-18
2011
school year 75% of students show
at 6
an increase in
community academic performance
schools
(50 students have
increased their grade
point average from 2.0
to 3.0, 10 students
have increased their
grade point average
from 1.0 to 2.0).
Location
Measurement tools
Aurora,
Illinois, USA
Teacher surveys
indicate that
students are
concentrating in
class more,
attendance records
show less absences,
pre and post‐
assessment surveys,
weekly and quarterly
measures reading
levels
District #123
1. Aurora High
2. Aurora
Middle
3. Aurora
Grade, etc.
Evaluation
Process
Surveys conducted
quarterly, and
results are shared
with all teachers
through newsletter.
School attendance for
all 60 students
improved from 70% to
85%.
Organization Name:
Program Title:
Program Goal:
Activity
1
2
Outputs
Outcomes
Number of
Location
Beneficiaries
Measurement
tools
Evaluation Process