Mosaic Community Grant Application
Prioritizing programs that support older adults, caregivers, and dementia-related initiatives across South Jersey
Application Deadlines:
- February 15
- May 15
- August 15
- November 15
Organizational Information
Organization Name
Email Address
Phone Number
Mailing Address
Address Line One
Address Line Two
City
State
Postal Code
Executive Director/CEO
Name
Email
Primary Grant Contact (or person applying for the grant)
Name
Title
Email
Phone
Federal EIN #
Year Founded
Website (if applicable)
If your organization is not a registered 501(c)(3), please list your fiscal sponsor
Eligibility Counties Served (Check all that apply)
Program Details
Program Title
Brief Summary of the Program (Max 200 words)
0 / 200 words
Which Mosaic pillar(s) does this program align with? (Check all that apply)
Program Description: Please describe the goals, target audience, and activities of this program. (Max 300 words)
0 / 300 words
What need does this program address, and how do you know it exists in your community? (Max 200 words)
0 / 200 words
What is the anticipated impact of this program? Include expected outcomes, who will benefit, and how you will measure success. (Max 500 words)
0 / 500 words
Total Program Budget
Total Amount Requested from Mosaic
Is this program already in progress, or is it a new initiative?
Attachments
Upload Your Organizational Budget for Current FY:
A detailed program budget, including how Mosaic funding will be used:
(Optional) Letters of support, outcomes data, or other supporting documents:
You can also outline your budget details below:
Acknowledgement
Is your organization willing to provide outcome reporting if selected for funding?
Digital Signature
