First Name
Last Name
Email address
Phone number
Title (Position)
Organization Name
What’s your Tax ID Number and organization website?
What’s the mission of your organization?
Please limit your response to to 512 characters or fewer.
Briefly describe the activity or project for which you are requesting funds? Include date and location.
Please limit your response to to 512 characters or fewer.
Amount of funding you are requesting from GEHA or a list of sponsorship opportunities for consideration.
Please limit your response to to 512 characters or fewer.
Describe how funds will be used, including a simple budget outline. List community needs or problems to be addressed and the number of individuals and geographic area that will benefit from this funding.
Please limit your response to to 512 characters or fewer.
How are GEHA employees connected to your cause? (Board service, volunteers, etc.)
Please limit your response to to 512 characters or fewer.
How does your nonprofit’s mission and programs align with GEHA’s giving strategy: focusing on strategic partnerships/programs addressing social determinants to improve the quality of health and well-being of individuals in the community?
Please limit your response to to 512 characters or fewer.
Are there any potential non-monetary support opportunities associated with this request? (Volunteers, in-kind donations, etc.)
Please limit your response to to 512 characters or fewer.
If chosen to receive a GEHA Gives grant, how will you acknowledge GEHA's gift in your organizational storytelling/outreach?
Please limit your response to to 512 characters or fewer.
How does your staff's race/cultural/gender identity/sexual orientation/disabilities compare to those for which you serve? Please provide percentages, where possible.
Please limit your response to to 512 characters or fewer.
How does your Board of Directors' race/cultural/gender identity/sexual orientation/disabilities compare to those for which you serve? Please provide percentages, where possible.
Please limit your response to to 512 characters or fewer.
Has your organizational leadership (staff and/or Board of Directors) participated in diversity, equity and inclusion training, relevant to the audiences in which you serve, within the past two years?
Please share any organizational change that has come from these opportunities. Also, please limit your response to to 512 characters or fewer.
Provide a link to your most recent nonprofit annual report.