Grant Application Forms

Application Date 05/22/2013

Welcome to Toyota's on-line grant application. Your application will be submitted to:

TMMTX

Please note that all fields marked with an asterisk are mandatory.

You should save the application if you have not completed it in 30 minutes and write down the application number. Click 'SAVE' at the end of the application and then choose the option to Save for Later. The system will display your application number at that time. You can then resume the application immediately, or at any convenient time.

If you have not saved the application within the last hour, the system will prompt you to save it.

You must complete the application within 60 days or it will be discarded.

*Legal Organization Name:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*Country:

*Is this a P.O. Box?

Mailing Address:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*Country:

*Phone:

*Website:

*EIN:

-
(##-#######)

*Has your organization ever applied under a different EIN?

*If you have applied under a different EIN, please indicate that number here:

-
(##-#######)

*Is your organization a chapter of a national organization?

*If so, what is the legal name of the parent organization?

*What is the EIN of your parent organization?

-
(##-#######)

*Mission Statement:
(2000 characters)

First Contact:

*First Name:

*Last Name:

*Title:

*Phone:

*Fax:

*Email:

Second Contact:

First Name:

Last Name:

Title:

Phone:

Fax:

Email:

Program or Event:

*Program or Event Title:

*Program or Event Description:
(4000 characters)

*Please select the category that best describes your project activities:

Does this project focus specifically on the Environment or Automotive Safety?

*Which type of support are you requesting?

*If you are requesting "In-kind", please describe your request in detail.
(2000 characters)


*Please provide a high-level budget for this project. Include total amount of donated funding. (2000 characters)

*What is the total administrative cost for this project? (Whole dollar amount. No commas, decimal points, or dollar signs)
*How will Toyota's contribution be used? (2000 characters)

*What other organizations are supporting the project named in this request? Please list the amount of support from each. (2000 characters)

*How will Toyota be recognized for this contribution?
Please list 3 objectives of the program / event for which you are requesting funding. For each objective, please tell us the current status of the condition you are trying to change. Also, please tell us the target condition you are trying to reach (how you will know you have accomplished your objective).
*Objective 1 (200 characters):
*Current Status 1 (200 characters):
*Target 1 (200 characters):
*Objective 2 (200 characters):
*Current Status 2 (200 characters):
*Target 2 (200 characters):
*Objective 3 (200 characters):
*Current Status 3 (200 characters):
*Target 3 (200 characters):
Organizations that receive grants will be asked to send a report including 'Updated Status' and 'Reflections' for each of the objectives after the program / event is completed.
Program / Event Begin Date (MM/DD/YYYY):
*Requested Amount: (Whole dollar amount. No commas, decimal points, or dollar signs)
*What amount is deductible? (Whole dollar amount. No commas, decimal points, or dollar signs)
Term of Program / Event (in months, numeric only):
*Which area(s) of the region / state / counties will this request benefit:


*Do any Toyota employees support your organization through volunteering, on board or committees, or through financial contributions?
*If so, please list their names and the nature of the involvement. (400 characters)

*Has Toyota (any U.S. Affiliate) supported your organization in the past?
*If so, please list dates and amounts in the past 12 months. (2000 characters)

*Has any Toyota employee requested you to submit this application?
If so, please specify the employee's name and title:
*Internal Requestor First:
*Internal Requestor Last:
*Internal Requestor Title:
*Internal Requestor Affiliation:
*Has anyone outside Toyota requested you to submit this application?
If so, please specify the requestor's name and title:
*External Requestor First:
*External Requestor Last:
*External Requestor Title:
*External Requestor Affiliation:
Under the Honest Leadership and Open Government Act of 2007 (HLOGA), Toyota is required to submit a semi-annual report, listing contributions and expenses related to government officials. Following questions help us capture mandatory compliance information.
*Are you a Member of Congress or an employee of either the United States House of Representatives or the United States Senate or a covered Executive Branch official¹?
*If so, please provide us with your name and official title. (2000 characters)

*Is this organization recognized as a 501(c) (3) charity?
*Was this organization established by one or more Members of Congress or a covered Executive Branch official?
*If so, please provide us with the name(s) and title(s) of the covered person(s). (2000 characters)

*Is this organization named for a current Member of Congress?
*If so, please provide us with the name(s) and title(s) of the person(s) for whom it was named. (2000 characters)

*Is this organization controlled by a current Member of Congress or a covered Executive Branch official, or does it have a Member of Congress or a covered Executive Branch official as an active participant on the board of directors?
*If so, please provide us with the appropriate name(s) and title(s). (2000 characters)

*Is this contribution for an event honoring or recognizing a Member of Congress or a covered Executive Branch official?
*If so, please provide us the appropriate name or names, together with the exact level of involvement you are requesting of Toyota insofar as honoring the official(s) named below. (2000 characters)

*Is this contribution or the charity for which it is intended involved in any way with any covered federal official?
*If so, please describe the level of involvement requested from Toyota in the specific event including requested contribution amount and any in-kind donations. (2000 characters)

Please tell us more about the clients served by this program/event. If your program/event is open to the general public, please provide your best estimates in each applicable category.
*# of participants in program/event:

Based on the number of clients you have indicated for this program/event, please tell us how many are:
It is okay to count the participants in multiple categories if they satisfy the category criteria.
Note - The sum of number of clients in each of the categories should at least be equal to the total number of participants in program / event.

*Developmentally, mentally or physically disabled:
*Economically Disadvantaged:
*Disaster Victims:
*Animals, Wildlife:
*Homeless:
*Veterans:
*Women:
*Men:
*Senior:

*Children:
*Lesbian, Gay, Bisexual, Transgender (LGBT):
*Asian or Asian American:
*Black or African American:
*Hispanic or Latino:
*American Indian or Alaska Native:
*Native Hawaiian or Other Pacific Islander:
*White:
*Other:
*If others, please specify:

Please also tell us about the composition of your board and staff.
It is okay to count the board members / staff in multiple categories if they satisfy the category criteria.
Note - The sum of number of board / staff members in each of the categories should at least be equal to the total number of board members and staff respectively.

Board:
*# of people on board:
*Asian or Asian American:
*Black or African American:
*Hispanic or Latino:
*American Indian or Alaska Native:
*Native Hawaiian or Other Pacific Islander:
*White:
*Women:
*Men:
*Lesbian, Gay, Bisexual, Transgender (LGBT):
*Veterans:
*Developmentally, mentally or physically disabled:
*Economically Disadvantaged:
*Disaster Victims:
*Homeless:
*Other:
*If others, please specify:

Staff:
*# of people on staff:
*Asian or Asian American:
*Black or African American:
*Hispanic or Latino:
*American Indian or Alaska Native:
*Native Hawaiian or Other Pacific Islander:
*White:
*Women:
*Men:
*Lesbian, Gay, Bisexual, Transgender (LGBT):
*Veterans:
*Developmentally, mentally or physically disabled:
*Economically Disadvantaged:
*Disaster Victims:
*Homeless:
*Other:
*If others, please specify:

Please allow 45 days for a response.

¹ Pursuant to IRC 162(e) (6), a "covered executive branch employee" includes:

The President,
The Vice President,
Any person serving in level I of the Executive Schedule (e.g., a Cabinet Officer) or
Any other person designated by the President as having Cabinet-level status and their immediate deputies,
Any other person designated by the President as having Cabinet-level status and their immediate deputies,
Any other official or employee of the White House Office of the Executive Office of the President.