Clear Fund Grant Application: Preliminary Questionnaire

Note: this is a reproduction of the questionnaire we used to collect information on US-focused charities, as described in our grant application process. Submitting the form will not do anything; this page is for display purposes only.

Also note that the original survey was broken into two pages, with the second pages displaying only the relevant sections (based on answers on page 1); we have reproduced the form on one page for simplicity.

This form is a simple, 5-minute survey intended to fill in some basic information about your organization that we weren't able to get from its Form 990. It is for our information only, to help determine your eligibility to apply for an unrestricted Clear Fund grant. It shouldn't be necessary to consult with anyone about your answers; we are looking only for very basic, general information about what your organization does, and our intent is for anyone with basic knowledge of your organization to be able to fill out this form quickly (if that isn't the case, please let us know).

Our funding priorities are not finalized, and may favor breadth in some cases and narrowness in others. Please simply answer all questions honestly, indicating the activities that are a significant part of what your organization does.

We appreciate your taking the time to fill out this form. If you have any questions, don't hesitate to contact us at grants@clearfund.org. More information about The Clear Fund is available at www.clearfund.org.

  1. Name of your organization:

  2. Employer identification number:

    (Entering this makes it easier to match your information to our existing record. If you do not enter it, we will find it by your organization's name.)

  3. Contact email:

    (All further correspondence about Clear Fund grants will be sent to this email)

  4. Contact phone:

  5. Would your organization potentially be interested in applying for a one-time unrestricted grant of $20,000 to $50,000, to enable it to help more people live better lives? (Note that the application process will be thorough and competitive, although it will concern only your existing activities, i.e., no project proposal will be required.)
    Yes No

  6. Does your organization primarily serve:
    A particular community within New York City
    Across New York City
    Across New York State, including NYC
    National scope, including NYC
    Global scope, including NYC
    None of the above / your organization does not serve NYC

  7. Please indicate which of the following areas make up a significant part of your organization's activities. Check each area that applies. If you provide support to other nonprofits, please indicate which types of organizations you focus on.
    Housing
    Adult education and employment assistance/support
    Health care
    Food
    Education (K-12)
    Youth activities (K-12)
    Preschool care, including Head Start and other day care programs
    Foster care, adoption services, and other services for children who cannot live with their biological parents

    Questions about your services for for children who cannot live with their biological parents

  8. How many group homes (if any) do you operate?
    None
    1
    2
    3 or more

  9. Do you provide foster care coordination services?
    Yes No

  10. Do you provide adoption services?
    Yes No

  11. Do you focus on children with behavioral problems?
    Yes No Only in some programs

    Questions about your services for preschool-aged children

  12. How many day care centers (if any) do you operate?
    None
    1
    2
    3 or more

  13. Do you operate a Head Start or Early Head Start program?
    Yes No

  14. Do you charge individuals for your child care services?
    Yes No

  15. Do your child care-related activities specifically focus on low-income children?
    Yes No Only in some programs

  16. Do your child care-related activities specifically focus on special-needs children?
    Yes No Only in some programs

  17. Do you engage in child care-related activities beyond operating day care centers, including financial aid and assistance to other child care-related charities?
    Yes No

    Questions about your services for school-age children

  18. What grade levels do your services for school-age children focus on?
    through

  19. Do you specifically focus on low-income children?
    Yes No Only in some programs

  20. Do you specifically focus on special-needs children?
    Yes No Only in some programs

  21. Do you specifically focus on academically challenged children?
    Yes No Only in some programs

  22. Do you specifically focus on academically gifted children?
    Yes No Only in some programs

  23. Do you specifically promote particular fields of study or particular future professions?
    Yes No
    If yes, please specify:

  24. Which of the following services for school-age children do you provide? Check each box that applies.
    Teacher/principal training and development
    Support of schools and the school system
    Extracurricular and recreational activities
    Tutoring programs
    Scholarships
    Comprehensive leadership training programs
    Support and assistance for related nonprofits
    Other related services and programs

  25. How many charter schools (if any) do you operate?
    None
    1
    2
    3 or more

    Questions about your services for all ages

  26. Do you provide free or below-market services to individuals in need?
    Yes No

  27. If the answer to #1 is yes, are your beneficiaries (the individuals eligible to receive free or below-market services from you) required to be:
    Elderly or infirm
    Physically or mentally challenged
    Either elderly/infirm or physically/mentally challenged
    Both elderly/infirm and physically/mentally challenged
    N/A

  28. What other qualifications are required of your recipients?
    Low-income
    Homebound
    Members of a particular ethnicity or gender (please specify: )
    Members of a particular organization (please specify: )
    Affected by a particular health problem or problems (please specify: )
    Other (please specify: )

  29. Is your primary function to operate or support a particular hospital?
    Yes No

  30. Is your primary function to address a particular disease?
    Yes No
    If yes, please specify:

  31. How many health clinics (if any) do you operate?
    None
    1
    2
    3 or more

  32. Which of the following healthcare-related services do you provide? Check each box that applies.
    Free or below-market health insurance
    Free or below-market direct care
    Support and assistance for related nonprofits
    Other health-related services and programs

  33. Do you charge for your adult education and/or employment assistance services?
    Yes No

  34. Which of the following adult education and/or employment assistance services do you provide? Check each box that applies.
    Literacy education
    English education (speaking)
    Mental health services
    Vocational education
    Personal loans
    Business development assistance
    Job placement assistance
    Support and assistance for related nonprofits
    Other related services and programs

  35. Which of the following housing-related services do you provide? Check each box that applies.
    Free or below-market temporary housing
    Free or below-market permanent housing
    Housing construction
    Temporary financial assistance
    Permanent financial assistance
    Job training, counseling, and placement assistance
    Support and assistance for related nonprofits
    Other housing-related services and programs

  36. Optional: how can we improve this survey? (In particular, share any thoughts on whether it was quick and simple, and whether we can make it more so.)