Sample Application Overview

Jewish Legacy Awards: The following information is required to complete an online application. This page is for planning purposes only. All requests must be submitted online.

Agency Name
Applicant Name(s) and Title(s):
(Please indicate primary contact name & email for content questions about this application)
Phone Email
Mailing Address Alt. Contact(s) and Title(s)
Project Title Start and end date of requested grant period
Total Project Budget Total Amount Requested from MZHF
Executive Summary: State the main goal(s) of the requested funding (2-3 sentences) and include a paragraph summary of the project and a paragraph overview of the organization
  1. Explicitly benefits underserved communities. Describe the project and its purpose, including the unmet health need, target population, and the estimated unduplicated numbers to be served; explicitly state how the project advances the health of one or more underserved populations who have limited access to quality health services because of inability to pay, health status, race, religion, language, gender identity, or sexual orientation.
  2. Shares Jewish roots. State how the project shares Jewish roots, and how the project enhances care and/or health education for the San Francisco community.
  3. Embodies one or more of MZHF’s core Jewish Values. Articulate how the project embodies one or more of MZHF’s core values.
  4. Addresses health equity or other compelling San Francisco healthcare priorities. Explain how the project addresses health equity or other compelling San Francisco healthcare priorities and list the specific goals (measurable outcomes) for the project numerically in order of priority. For each of the goals listed, provide a brief evaluation plan for collection of information (for example, using data from a client survey or from metrics such as number of clients served) to facilitate MZHF’s assessment of the project’s success in meeting its stated goals. To receive funding, the proposal must include a plan for evaluation with both quantitative and qualitative outcomes.
  5. Potential impact of the project is significant. Describe the significant potential impact of the project.
  6. Team can successfully complete the project on time/budget. Provide a list of key project staff with qualifications, and a project timeline documenting plans to successfully complete the project on time/budget.
  7. Applicant can articulate plan for financial sustainability of project beyond the grant period. Articulate the plan for financial sustainability of the project beyond the grant period (if ongoing intervention is proposed).
  8. Include the following budget-related and other attachments:
    1. Total proposed project budget, with justification, and including the following details: proposed grant period; line item breakdown of revenue and expenses; staff FTE commitments; specifically indicate the portion of the budget for which funding is requested from MZHF)
    2. Agency current year total budget (specify calendar or fiscal), with line item breakdown of revenue and expenses and staff FTE commitments
    3. List of committed, pending and proposed funders for the proposed project
    4. Board of Directors list
    5. IRS determination verifying 501(c)(3) status (submit only if not previously funded by MZHF)