Fellows Collective Impact on-line form

Primary Applicant

First Last

Primary Applicant Organization

Primary Applicant Email

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Primary Applicant Preferred Contact Number

Partnering Applicant

First Last

Partnering Organization

Partnering Applicant Email

Enter Email Confirm Email

Partnering Applicant Preferred Contact Number

Additional Partnering Organization

1. Identify which of the applicants is a Jameson Fellow (any of the 6 cohorts allowed)

2. Which community need outlined in the Jameson Fellows grant expectations will your collective impact address?

3. Please provide a detailed and compelling program/project narrative that clearly describes how the partnering applicants will address an identified community need (maximum of 750 words)

4. Explain how the partnering applicants will measure the impact of the program/project, being sure to include the number of lives that will be impacted and how the anticipated outcomes will be measured (maximum of 300 words)

5. Clearly describe how the partnering applicants will sustain the program/project long- term (maximum of 250 words)

6. What makes your application stand out as a Collective Impact leader in our community (maximum of 250 words)

7. Please Attach the Following Primary Applicant Documents

a. IRS Determination Letter (if applicable)

b. Board Member List (if applicable)

c. Organizational Chart (if applicable)

Please complete the Form below.

7. Please Attach the Following Primary Applicant Documents

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