Grant-Writing Mental Health Questionnaire – Dewlyn Nonprofit Services

Hello!

Thank you for your interest in our services for your Mental Health Program! We’d love to help you position your organization for grant funding, but first we’d like to learn more. After completing this form, you’ll be directed to a link to schedule your phone meeting with Cheryl Smith.

Heads-up! The first 10 questions are required!

Thank you!

We'd Like to Get to Know You!

Thank you for your interest in grant-writing with Dewlyn Nonprofit Services. The purpose of this questionnaire is to gather information about your nonprofit organization, capturing details that will aid in the grant-writing process. Please try to complete as much of the questionnaire as possible. If a question does not apply to you, simple select or type in “n/a.”

1. Your Name: *

First

Last

2. Your Title: *

3. Your Email: *

4. Your Phone Number: *

About the Organization

A nonprofit organization is a type of legal entity. It’s typically set up to focus on furthering a social cause or advocating for a shared point of view, rather than generating profits for owners or shareholders.

5. Organization Name: *

Please enter the full legal name

6. Organization Physical Address: *

Address Line 1

Address Line 2

City

State

Zip Code

7. Organization's Main Phone: *

8. Organization's Public Email: *

9. Briefly share what your organization does (or will do) each day: *

10. Are you ready to engage in Grant-Writing services? *

Optional

The remainder of the questions on this form are “optional” and intended for organizations that are serious about grant-writing. If you would simply like to meet with Cheryl Smith to learn more about our services, it’s okay to stop here, submit the form, and schedule your appointment!

Thank you for your interest!

11. Website / URL

12. Organization EIN

13. When was your organization incorporated or established?

14. When does your fiscal year end?

15. What is the Organization's Mission Statement?

16. Who founded the organization? Please also share details which will help Cheryl Smith understand why the organization was founded.

17. What programs are offered by your organization:

About Your Mental Health Nonprofit Service(s)

This term is more specific and action-oriented. A service is an activity or set of activities that a nonprofit carries out to benefit its target group or further its mission. This could include providing food and shelter to the homeless, offering free legal advice to low-income individuals, or organizing workshops for skill development. Services are often, but not always, part of a nonprofit’s program.

18. What specific mental health challenges or gaps is your organization is addressing?

19. What is the name of your mental health program?

20. What types of mental health services does this program offer? (select all that apply)

Example: Individual counseling, group therapy, crisis intervention, case management, prevention workshops, other.

21. Who delivers mental health services? (Select all that apply)

Example: Board, staff, volunteers, licensed clinicians, peer support specialist, other.

22. How are mental health services delivered?

In person – at our housing unit
In person – at an offsite location
Virtually
All of the above

Example: on-site, off-site, virtually

23. What follow-up or aftercare services, if any, do you provide once initial services are completed?

24. Does the program offer housing?

25. Are there eligibility requirements for your services (e.g., age, income, diagnosis)?

26. How do clients access your services?

27. Is there a fee for your services?

28. How many clients do you plan to serve through during this fiscal year?

29. Describe your target population (age range, gender, ethnicity, income levels, special populations such as veterans, LGBTQ+, foster youth, etc.).

30. What are 3 main goals you want to achieve through this program?

31. List any key partners, collaborators, or community organizations you work with.

About Your Request for Funding

Your responses to the next set of questions will help Cheryl Smith understand where to place her focus for grant-writing.

32. Have you applied for grants in the past?

33. How much are you seeking in grant funding?

IMPORTANT: Cheryl Smith will not prepare this grant proposal to seek funding over $250,000. Also, the organization and program budget determines the amount of funding that should be sought.

35. If awarded, what will you spend the money on?

36. Please share any questions or comments that you have for Cheryl Smith:

37. Please confirm your authority to engage in grant-writing services by typing in your full name below:

38. Today's Date