Capital Times Kids Fund Impact Grant Please enable JavaScript in your browser to complete this form.Grant Proposals must be time-stamped by 11:59pm, 03/01/2026 This $20,000 grant is intended to support a one-time expense that enhances youth mental health services (YHMS) in a sustainable and lasting way. Funding should be used for investments such as equipment, technology, facility improvements, training, program development or similar one-time expenses that will have a long-term impact on the quality, accessibility, and effectiveness of youth mental health care. Organizations applying for funding must be non-profit 501(c)(3) and have significant experience providing youth mental health services within Dane County. IDENTIFYING INFORMATIONName of Organization: *Contact Name: *FirstLastOrganization Address: *City: *State: *--- Select Choice ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip: *Contact Telephone: *Upload a copy of the IRS determination letter of your 501(c)(3) status or, if your organization is pending approval, a copy of your request form & receipt of submission: Drag & Drop Files, Choose Files to Upload Email: *Tax Exempt I.D. Number: *ORGANIZATIONAL MISSION AND SOURCES OF SUPPORTProvide a brief description of your organization and its history of providing youth mental health services in Dane County.What is the approximate size of your current annual budget? *What percentage of your annual budget goes toward serving youth mental health services? (21 years & younger)? *What are your main sources of financial support and the percentage of each? *PROPOSED PROJECT AND GOALSPurpose of Funding:Describe the specific challenge your organization experiences related to YMHS and hopes to address with this project. (limit to 300 words)Purpose of Funding Prompt:Provide a Description of This Project (Limit to 100 words):Impact on Care (Limit to 500 Words):How will this investment address the challenge described above? How will it enhance youth mental health services, improve the effectiveness of services, or make services more accessible for youth?Impact on Care Prompt:Integration & Sustainability (Limit to 500 Words):This is a one-time grant and funds must be used within one year of the award. How will you integrate this investment into your current programs or services and sustain it so that it continues to have an impact in future years?Integration & Sustainability Prompt:Upload Any Supporting Documents:Documents can provide visual information or evidential support for narrative responses and should be specifically referenced in your responsesUpload Any Supporting Documents Prompt: Drag & Drop Files, Choose Files to Upload You can upload up to 10 files. BUDGETProvide a detailed budget and timeline for use of the funds. All funds must be expended within 1 year of the award date.Upload a budget document formatted similarly to the table below.Description of ExpenditureTimelineAmount of CTK FundingAmount & Source of Other Funding Total percentage Impact Description Description of Expenditure-1Timeline-1Amount of CTK Funding-1Amount & Source of Other Funding-1Total-1Description of Expenditure-2Timeline-2Amount of CTK Funding-2Amount & Source of Other Funding-2Total-2Description of Expenditure-3Timeline-3Amount of CTK Funding-3Amount & Source of Other Funding-3Total-3TotalAmount of CTK Funding-TotalAmount & Source of Other Funding-TotalTotal-TotalUpload Budget Document: * Drag & Drop Files, Choose Files to Upload Submit
