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Application Information

Program:

Grant Round:

Organizational Involvement

Will this project utilize a fiscal sponsor? If the answer to this question is no, please do not check the box and proceed to the next question.

Yes, we use a Fiscal Sponsor

Organizational Information

Organization Name

EIN

Website

Country

Street Address

State / Province

City

State

Zip / Postal Code

Primary Contact Information

First Name

Middle Name

Last Name

Suffix

Work Email

Work Phone

Title

Pronouns

Fiscal Sponsor Information

Organization Name

EIN

Website

Country

Street Address

City

State / Province

State

Zip / Postal Code

Fiscal Sponsor Primary Contact Information

First Name

Middle Name

Last Name

Suffix

Work Email

Work Phone

Title

Pronouns

Organizational Demographics

AIDS United seeks to understand the leadership and staff of the organizations we fund, as well as the communities they serve.

We recognize that these labels are imperfect. We are committed to continued learning, updating our language and being cognizant of the ways in which HIV status, race, gender identity and sexual orientation impact people’s access to power.

People of color can include anyone who self-identifies as any ethnicity and/or race that does not fit within the United States definition of "white" There will be some duplication with other race and ethnicity questions.
Nonbinary people can include agender, genderfluid, and gender non-conforming people.

Approximately what percentage of your organization’s leadership identifies as part of the following groups? Feel free to include the Executive Director, Board of Directors, and other senior leaders as may apply to your organization’s structure.

If your organization does not collect data needed to answer this question, select "unsure."

	0-25%	26-50%	51-75%	76%+	Unsure/prefer not to answer
People living with HIV
People of color
Asian, Asian American, East Asian, South Asian, Southeast Asian, Southwest Asian, and Central Asian people
American Indian, Native American, or Alaska Native people
Black/African American/African/Afro Caribbean people
Latino/Latina/Latinx/Latine/Hispanic people
Native Hawaiian people or other Pacific lslanders
White or Caucasian people
Lesbian, gay, bisexual, queer, asexual, aromantic, and same-gender-loving people
Heterosexual people
Women of trans experience
Men of trans experience
Cisgender women
Cisgender men
Nonbinary people
People who use drugs
Sex workers
People who are or have been unhoused / unstably housed
People with a history of incarceration
People aged 24 and under
Dandelions/Lifetime Survivors
People with other relevant lived experience (specify below)

Other leadership demographic(s)

Approximately what percentage of your staff identify as part of the following groups? If volunteers conduct a significant portion of your activities, feel free to include them. If your organization does not collect data needed to answer this question, select "unsure.

	0-25%	26-50%	51-75%	76%+	Unsure/prefer not to answer
People living with HIV
People of color
Asian, Asian American, East Asian, South Asian, Southeast Asian, Southwest Asian, and Central Asian people
American Indian, Native American, or Alaska Native people
Black/African American/African/Afro Caribbean people
Latino/Latina/Latinx/Latine/Hispanic people
Native Hawaiian people or other Pacific lslanders
White or Caucasian people
Lesbian, gay, bisexual, queer, asexual, aromantic, and same-gender-loving people
Heterosexual people
Women of trans experience
Men of trans experience
Cisgender women
Cisgender men
Nonbinary people
People who use drugs
Sex workers
People who are or have been unhoused / unstably housed
People with a history of incarceration
People aged 24 and under
Dandelions/Lifetime Survivors
People with other relevant lived experience (specify below)

Other staff demographic(s)

Approximately what percentage of your clients or beneficiaries identify as part of the following groups? If your organization does not collect data needed to answer this question, select "unsure."

	0-25%	26-50%	51-75%	76%+	Unsure/prefer not to answer
People living with HIV
People of color
Asian, Asian American, East Asian, South Asian, Southeast Asian, Southwest Asian, and Central Asian people
American Indian, Native American, or Alaska Native people
Black/African American/African/Afro Caribbean people
Latino/Latina/Latinx/Latine/Hispanic people
Native Hawaiian people or other Pacific lslanders
White or Caucasian people
Lesbian, gay, bisexual, queer, asexual, aromantic, and same-gender-loving people
Heterosexual people
Women of trans experience
Men of trans experience
Cisgender women
Cisgender men
Nonbinary people
People who use drugs
Sex workers
People who are or have been unhoused / unstably housed
People with a history of incarceration
People aged 24 and under
Dandelions/Lifetime Survivors
People with other relevant lived experience (specify below)

Other client demographic(s)

Explain any disparities between your organizational composition and the communities it serves. Describe your efforts to address such disparities, including plans, timelines, and responsibilities for those plans.

Explain any challenges you experience when collecting this data. Note that estimates are fine.

Budget Information

Total Organizational Budget Amount for Current Fiscal Year

Enter amount in USD.

Current Budget Year Start Date

Current Budget Year End Date

The Harm Reduction Futures Fund offers grant support only to syringe services programs providing direct services. Organizations are invited to submit proposals for $10,000 to $25,000 for one year. AIDS United anticipates 5-13 programs will receive funding.

Total Funding Amount Requested

Enter amount in USD.

Conflicts of Interest

Are you or any member(s) of your organization an employee of AIDS United, a member of AIDS United's Board of Trustees, or a member of the Public Policy Council (PPC)?

Primary Contact has a relationship with AIDS UnitedOther team member(s) have a relationship with AIDS UnitedOur team member(s) do not have a conflict of interest with AIDS United.

Primary Contact's Role with AIDS United

EmployeeBoard of TrusteesPublic Policy Council

	First Name	Last Name	Role with AIDS United
Additional Contact Person & Role			EmployeeBoard of TrusteesPublic Policy Council

Managing conflicts of interest:

I attest that the person(s) indicated above will recuse themselves from any decisions associated with this funding.

Narrative and Description

Provide a brief description of your organization.

Provide a brief description of your proposed project

If you are applying as a high need/low resource SSP, provide a brief description as to why you fit this category

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