Thank You for you Applying!

In order to complete your application, please answer the following questions and send them to:


222 Merchandise Mart
Suite 1647A
Chicago, IL 60654

  1. Organization type and organizational structure
    1. Identify the primary contact person for your organization who will lead the project/program (name, title, e-mail, phone)
    2. Identify organization’s list of officers
  2. Organization’s Mission
    1. Submit mission statement and focus of current programs
    2. Include service population (number of actual HIV/AIDS related cases). We want to understand your focus on HIV/AIDS and how your funding request relates.
    3. What significant difference does your agency provide?
  3. Description of Project/Program you would like to use DIFFA/Chicago Funding for
    1. Describe the project/program
      1. Impact: What impact do you intend to make with the program.
      2. Evaluation: How will you measure success?
      3. Time Line: What is the schedule? This does not need to be a one year project.
      4. Project Budget:  Submit a detailed budget of up to $25K that will support our evaluation process and defines specifically the DIFFA grant will be we used:
      5. Or Program Funds:  Define how our grant will sustain an existing or new program.
    2. Since our grants are not restricted, please share with us how funds are used to most impact your program/project.
    3. Describe a post grant award communication strategy to allow DIFFA to get updates on your program and feedback on measurable results of the project we are supporting.
  4. Financial
    1. Submit a financial statement from the past two (2) fiscal years
    2. Submit a list of your top 10 funding sources and amounts for the previous two (2) years
    3. If you have received an Excellence in Care Award, provide a brief description of how the funds were used.  How many individuals were impacted?
    4. Submit information to demonstrate operating expense to direct client care ratio.

If you have any questions, feel free to reach out:

(312) 644-6412
Fax: (312) 644-6413

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