Section 1

Name of Organization*

Organization Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organization Website*

Registered Charitable Number*

*Must be registered in Canada

What year was your organization founded?*

Point of Contact Name*

First Last

Role at Organization*

Point of Contact Phone*

Point of Contact Email*

Section 2

Tell us about your organization*

How does your organization break down barriers to employment?*

Number of Employees in Organization*

Number of Volunteers in Organization*

What is your annual operating budget?*

Do you prepare audited financial statements?*

Yes
No

Which social media platforms are used by the organization?

Facebook
Instagram
Twitter
Linkedin

What is the organizations Facebook url?*

What is the organization's Instagram handle?*

What is the organization's Twitter handle?*

What is the organization's LinkedIn url?*

Section 3

Name of program you're requesting funds for*

Program Summary*

Program Objectives*

Please include any metrics or targets you’re looking to achieve through the program

Start Date of Program*

Amount Requested*

What will your program gain from the funds provided?*

i.e. new hires, micro loans, ability to launch a new program, etc.

What is the targeted demographic this program will reach?*

Please provide details of any other significant funders of the organization/program/project which the grant request will support*

Do you have a program budget you'd be willing to share with us?*

Yes
No

Does your program have a conclusion date?*

Yes
No

What is the conclusion date?*

Will you provide us with an Impact Report within 12 months of receiving funds?*

Yes
No

What opportunities, if any, exist for Ian Martin Group employees to volunteer with your organization?*

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