If you’re from Walmart, please don’t sue me. This is for class.
If you’re from class, this is the form for the Walmart Local Community Grant as of Spring 2020.
Contact Information
Name: [Primary contact’s name—that’s you!]
Contact Title: [Primary contact’s title with organization]
Address: [Primary contact’s street address]
City: [Primary contact’s city of residence]
State: [Primary contact’s state of residence]
Zip: [Primary contact’s zip code]
Telephone: [Primary contact’s phone number]
Email Address: [Primary contact’s email address]
Contact Type: [Primary contact “type,” selected from a menu on the form. Ex. “Board Member,” “Owner.”]
Contact’s Role: [Primary contact’s role with organization]
Organization Profile
Official Name: [Organization Name]
Address: [Street address of organization’s primary address.]
City: [City of organization’s primary address.]
State: [US state or territory of organization’s primary address.]
Zip: [Zip code of organization’s primary address.]
Telephone: [Organization’s phone number.]
Organization Mission: [Your organization’s mission statement, if any. It’s good to have.]
Request History
Previous Funding: [Any amount previously awarded from Walmart. If none, use N/A.]
Program Information
Program Title: [Title of project or program.]
Program Focus Area: [Short descriptor. This and the next two are options chosen from a list on the form, but you can generate your own here. Like “Healthy Living.”]
Program Focus Category: [Short descriptor, like “Healthy Eating.”]
Program Subcategory: [Short descriptor, like “Kids’ Nutrition.”]
Unmet Need/Problem Statement: [1-2 paragraph gap statement.]
Fund Use: [1-2 sentence description of what the funds are used for.]
Program Description: [Minimum 1 paragraph description. Aim for concise rather than short.]
Primary Target Population: [1-2 paragraph description]
What state is this request for? [US state or territory]
Area Served: [Geographic area. Needs a Walmart in it.]
Desired Results: [1-2 pararaphs. This is your goal statement.]
Program Sustainability: [1-2 paragraphs describing how your program will continue to exist after Walmart’s funding is used up.]
Organizational Budget: [Total annual budget of the organization that manages your group. This and the program budget can be the same if your organization and program are the same (common for very small organizations).]
Program Budget: [Total annual operating budget of this program within your organization.]
Request Grant Amount: [Equal to or less than your budget]
Budget Breakdown
Program Budget Items: [List]
Explanation of Materials and Supplies: [1-2 paragraphs]
Demographics
People Served: [Number and type. If there are more than one demographic served, describe them each individually.]
Program Metrics:
Service Type: [Short descriptor, like “Nutrition” or “Public Transportation”]
Site/Location Types: [List]
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