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2. Lead person/community group/organization(s): *
4. Contact Name:*
5. Phone:*
6. Email:*
8. Mailing Address:*
10. City:*
11. State:*
12. Zip:*
14. Have you received prior City of Dubuque grant? *
    -- Select One --YesNo
15. Which grant, and what year?*
17. Project Title: (7 words or less)*
19. Grant Purpose: In 50 words or less, describe how the grant will be used. *
21. Grant Narrative: In 400 words or less, briefly describe the project/idea, the goals of the project, who will benefit, your experience impacting your community, your capacity to complete this project and why you are confident you will be able to produce results if awarded this grant.*
23. Primary City Council Goal
    -- Select One --Robust Local Economy: Diverse Businesses and Jobs with Economic ProsperityVibrant Community: Healthy and SafeLivable Neighborhoods and Housing: Great Place to LiveFinancially Responsible, High Performance City Organization: Sustainable, Equitable, and Effective Service DeliverySustainable Environment: Preserving and Enhancing Natural ResourcesPartnership for a Better Dubuque: Building our Community that is Viable, Livable, and EquitableDiverse Arts, Culture, Parks, and Recreation Experiences and ActivitiesConnected Community: Equitable Transportation, Technology, Infrastructure, and Mobility
25. Project Location: Physical address or neighborhood (if applicable).
29. Amount of Money Requested: Name an amount up to $10,000 that is requested from the Office of Equity and Human Rights.*
30. Grant Budget, Deliverables, and Timeline Table.
    Download and complete the table.
32. Completed Grant Budget, Deliverables, and Timeline Table.

    Save and upload your completed version of the Grant Budget, deliverables, and Timeline Table. You may upload your own version/a more detailed record of your projects budget, deliverables, and timeline if you have already created one.

36. Does your project address a City of Dubuque 5-year goal, Imagine Dubuque Plan or another adopted City plan?

    1. City of Dubuque 5-year goal
    2. Imagine Dubuque Plan
    3. Another adopted City of Dubuque plan (please indicate below)
38. Other Related Plan:
40. Explain how your project is in alignment with the plan(s) above: (50-word max).
44. Minority Impact Statement: Please choose the statement(s) that pertains to this grant application. Complete all the information requested for the chosen statement(s).

    1. The proposed grant project programs or policies could have a disproportionate or unique POSITIVE impact on minority persons.
    2. The proposed grant project programs or policies could have a disproportionate or unique NEGATIVE impact on minority persons.
    3. The proposed grant project programs or policies are not expected to have a disproportionate or unique impact on minority persons.
46. All projects must include community engagement and/or community education. Please explain how you will incorporate one or both in your project. (100-word maximum).
48. How will measure your impact and what does project success look like? (300-word maximum).

    All grantees will be required to complete a performance report summarizing basic impacts, such as number and demographics of people reached through the project. Who will be better off? What change will you see? How will you measure impact of your project? Good performance measures include not only who was served but how it impacted their life/experience/situation.

52. Experience Applying for this Grant: Please select the phrase which best describes your experience filling out this form and use the additional space to explain anything else we should know about your experience filling out this grant application. *
    -- Select One --Delightfully easy! Clear, concise and I was able to share my idea without being over-burdened. (Positive)Pretty typical grant application. If you’ve done one, you’ve done them all. (Neutral) That was awful. I needed help, it didn’t make any sense and the application isn’t worth the funding. (Negative)
54. Additional explanation of above rating:
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field