MKM Melanoma Research Fund

MKM Melanoma Research Fund is sponsored by Melanoma Know More. This annual grant supports medical research devoted to ending melanoma for programs in Ohio, Kentucky & Indiana. The fund focuses on research and increasing opportunities for finding a cure through work with leading melanoma and cancer research individuals and organizations.

Thank you for you taking interest in the MKM research grant. Please fill out the form form below.

Fields marked with an * are required **Organization Information** Applicant Organization (Full Legal Name) * Name, as listed on 501(c)(3) Letter * Name of Executive Director * Organization Financial Information **Organization Financial Information** Organization's Budgeted Expenses for Current Year (give fiscal year end mm/dd/yy) * Endowment Size (market value as of fiscal year mm/dd/yy) * Organization's Major Funding Sources by percentage (e.g., United Way, local community foundation, county board of health, etc.) * Organization's Affiliations **Organization's Affiliations** * Chapter of national or regional organization If Chapter of national or regional organization, please specify Total Budget for this Program/Project * Anticipated Project Start Date * Community/Counties served by this Program/Project * Total Number of people to be served during grant period * Brief demographic description of population served by this Program/Project * Please check all that apply * * Program/Project Start-up **Signatures (both are required unless otherwise specified by funder)** Signature of Executive Director * Signature of Board President * Melanoma Know More Grant Application The narratives for Sections Two through Six, should not exceed five pages.

Responses should be single-spaced, single-sided and use a 12-point type. **Melanoma Know More Grant Application** **The narratives for Sections Two through Six, should not exceed five pages. Responses should be single-spaced, single-sided and use a 12-point type.

** SECTION TWO: PROFILE OF ORGANIZATION **SECTION TWO: PROFILE OF ORGANIZATION** 1) Brief summary of organization's history * 2) Brief statement of organization's vision/mission * 3) Brief description of current programs/projects and activities * 4) Description of population and geographic region served by organization.

* SECTION THREE: STATEMENT OF NEED **SECTION THREE: STATEMENT OF NEED** 1) What is the problem, challenge or need that is unaddressed or unmet? Or what is the community benefit that this program or project will impart? * What is the research, statistic(s) or evidence that shows this need or benefit exists?

* SECTION FOUR: PROGRAM/PROJECT DESCRIPTION & METHODOLOGY **SECTION FOUR: PROGRAM/PROJECT DESCRIPTION & METHODOLOGY** 1) Description of program/project, including: **1) Description of program/project, including:** Activities to accomplish program/project (is this a new or ongoing activity?)

* Timetable for implementation and duration of program/project * Evidence of use of best practices (For example, is this program/project based on a program that has been shown to be effective in other settings? Is it based on national standards?) If the initiative is a pilot project and has not been done before, please list assumptions on why new approach will succeed.

* 2) Will the organization collaborate with other organizations (if so, with whom and how?) * Why is your organization qualified and appropriate to address this need or benefit? * SECTION FIVE: EVALUATION AND RESULTS **SECTION FIVE: EVALUATION AND RESULTS** 1) How will success be defined and measured, for example what are the short term, intermediate and/or long term outcomes?

* 2) How will the evaluation be conducted? * 3) How will the people served be involved in the program/project evaluation? * 4) How will the results be used and disseminated?

* SECTION SIX: PROGRAM/PROJECT FUNDING PLANS **SECTION SIX: PROGRAM/PROJECT FUNDING PLANS** 1) List of other funders to whom this current proposal has been and will be submitted. For each funder, indicate amount requested and status of request (e.g., "to be submitted", "pending", "funded", or "declined"). If funded, specify amount of grant.

* 2) Other anticipated funding including: **2) Other anticipated funding including:** Anticipated future/long-term funding strategies and sources if appropriate. Anticipated future/long-term funding strategies and sources if appropriate. SECTION SEVEN: REQUIRED FINANCIAL ATTACHMENTS **SECTION SEVEN: REQUIRED FINANCIAL ATTACHMENTS - Please scan forms and email them****to info@melanomaknowmore.

com**. **Also please include business name in subject line. ** 1) Statement of Revenue/Support and Expense* for your organization's most recently completed fiscal/calendar year.

2) Balance Sheet for most recently completed fiscal year. 3) Most recent, complete audit including auditor's note. If the organization does note have one, then send the most recent 990.

4) Budget for current fiscal/calendar year including a column showing the organization's year-to-date status. 5) Project Request Budget* for your entire project SECTION EIGHT: REQUIRED NON-FINANCIAL ATTACHMENTS **SECTION EIGHT: REQUIRED NON-FINANCIAL ATTACHMENTS -****Please scan forms and email them to info@melanomaknowmore. com****Also please include business name in subject line.

** 1) IRS letter of determination 501(c)(3) 2) Names and professional affiliations of board members 3) List of key staff members and qualifications, or an organizational chart 4) Any promotional material you would like to submit. 5) Letters of commitment from collaborating organizations, is appropriate. The applicant agrees to use grant funds within 12 months of the date the Board of Melanoma Know More approves the grant.

The applicant will use the funds only for the purposes requested and submit a written report on how the grant was used. If it becomes clear that the fund will be not be used for the purpose requested, the applicant will return the funds within the 12-month grant period. The grant shall be used by applicant exclusively to fund expenses directly attributable to the activities specified in the grant request.

Such expenses include all direct expenses and a reasonable allocable share of general and administrative costs connect with such activities.