Proposal Information – The John Randolph Haynes and Dora Haynes Foundation

THE JOHN RANDOLPH AND DORA HAYNES FOUNDATION PROPOSAL INFORMATION FORM

Introduction
Thank you for your interest in The Haynes Foundation, and for the work you do to improve the lives of Los Angeles Region residents. All fields in Part One and Part Two must be completed in order to submit this PIF.

What To Do First
Before you submit, review the Foundation’s website at www.haynesfoundation.org and you will find several Foundation references:
• our Annual Poster
• our list of Funding Priorities
• detailed descriptions of our grants and fellowships programs
• a searchable grants database, and
• FAQs to determine whether your request is a good fit for the Foundation.

Important Reminder
Your research must be directed to a specific and pressing public policy issue within the five county Los Angeles Region.

Helpful Tips To Complete this Form
• Please use only letters and numbers and limit your use of other characters.
• Insert the name of university/organization only (40 characters) (e.g. University of California, Los Angeles)
• To avoid loss of information, assemble answers in a separate document and copy and paste as needed.

Type of Haynes Foundation Award being Sought *

Full Name of Qualified Non-profit Organization *

Title of Proposal (125 Characters Max, LETTERS ONLY) *

Short summary of the public policy issue being researched (500 Characters Max, LETTERS ONLY) *

Can you confirm that the public official with the primary responsibility for this issue is aware of and/or likely to use this research?

Amount Requested *

Start Date *

Completion Date *

Principal Investigator Information

Prefix *

Suffix

First Name *

Last Name *

Present Position *

Department *

Organization/School *

Mailing Address *

Mailing Address 2

Mailing City *

Mailing State

Mailing Zip Code *

Contact Telephone *

Contact Email *

Organization Information (University or other 501 (c)(3) institution)

Prefix *

Suffix

First Name *

Last Name *

Present Position *

Department *

Organization/School

Mailing Address *

Mailing Address 2

City *

State

Zip Code *

Contact Telephone

Contact Email

Name and Address of Organization as it should appear on an Award Check (if different from above)

Name of the Organization

Address of the Organization

Address 2 of the Organization

City, State, and Zip