The AHF Fund

Application

As an expert in the delivery of HIV/AIDS medical care and an influential advocate, AIDS
Healthcare Foundation is on the forefront of efforts to control AIDS globally. We develop
and advocate for effective prevention strategies, work towards expansion of HIV testing
worldwide and play a major role in the scale-up of antiretroviral treatment delivery.

AHF provides treatment, care, and support services to more than 600,000 individuals
living with HIV/AIDS in the U.S., Africa, Asia, Latin America, Caribbean, and Europe. Its
successes have led AHF to decide to include philanthropic efforts as one part of its
strategy to control the HIV epidemic, by providing financial support to needy charitable
organizations worldwide who share AHFs goal of ending HIV/AIDS. Therefore, in
accordance with AHFs evaluation policies and procedures, AHF will award funding to
organizations whose activities advance one or more of the following goals:

1. prevent new HIV infections

2. increase awareness of HIV status
3. provide access to quality HIV care
4. provide leadership on community solutions to HIV stigma and/or barriers to
testing and care

Kindly complete the application in the given format (maximum of 5 pages). Applications
in any other formats will not be evaluated and returned to the applicant.
 Cover Sheet

I. Applicant Information

Organization:

Address:

City:

State:

Country:

Zip:

Date:

Phone Number:

Fax Number:

Website:

Employer ID
Number:

Executive
Director:

Title:
(Mr./Ms./Ms./Dr.)

Email Address:
 II. Information Regarding Program for which Funding is Requested

Program
Title

Program
Contact

Email
Address

Title
(Mr./Ms./Ms./Dr.)

Telephone

Organization Annual
Operating Budget
(in USD)

Total Program
Budget (in USD)

Total Amount
Requested (In USD)

III. Application Checklist (All boxes must be checked before submission)

Supporting Documents Required Must be in English

ALL DOCUMENTS MUST BE SUBMITTED IN ORDER TO BE EVALUATED
Application Coversheet
Application (including Proposed Program Narrative, Proposed Program Budget, and
Disclosures). Include:
o Board of Directors list
o Organization chart (if you have one)
o Budget must be in US dollars
IRS determination letter of 501(c)(3) status or (for non-U.S. organizations) other evidence
of registration as a charitable, non-profit organization
W-9 Form or W-8 Form
Application must be between 2-5 pages and in the AHF Grant Fund Application
format

_____________________________________ _______________
Signature of Executive Director or Board President Date

Email completed application & supporting documents to ahfgrantfund@aidshealth.org. Please direct any questions you may
have to the same email address.
AIDS Healthcare Foundation
AIDS Healthcare Foundation 3
Grant Proposal Application 2017
 AHF Fund Application
I. Proposed Program Narrative (2 to 5 pages MAXIMUM)

Applications cannot be evaluated unless it comes with a submitter form from an

AHF staff. Please provide the following information by answering questions (1 to
3). This section should be in this format and should include:

1) Organizational Description, History and Capacity

a) What is your organizations mission and purpose of your organization? How long has
your organization been providing programs and services to the community?
b) What are some of your organization's past accomplishments?
c) List all countries where you operate
d) What are your key programs and activities?
e) What is your current staffing? Please provide an organization chart if you have one.
f) Please provide a list of all Board directors of your organization.
g) Has AHF funded your organization in the past? If so, describe.

2) Program Proposal Information

a) Needs Statement: Specify the community need you want to address for which you are
seeking funds for. Why is there a compelling need for services to this community?
b) Program Goal, Objectives and Methodology
i) State your program goal. Describe your program.
ii) How does your program meet the community need? What is unique and innovative
about this program?
iii) Specifically address how your proposed program advances one or more of the
following goals: (1) prevent new HIV infections; (2) increase awareness of HIV status;
(3) provide access to quality HIV care; (4) provide leadership on community solutions
to HIV
c) Who are other funders supporting this program or potential funders that you are in
contact with? Why do you need AHF to be a part of that? What other local community
groups or local government entities do you collaborate or engage with? How are you
utilizing volunteers?
d) State one to three objectives for use of AHF funds. Objectives should be specific,
measureable, action-oriented, realistic, and time-specific. Specify the activities you will
undertake to meet each objective. Use the following format for your objectives and
activities:
i) Objective I:
Activities:
ii) Objective II:
Activities:
iii) Objective III:
Activities:

Measurable Objectives Expected Outcomes

1. 1.
2. 2.
3. 3.
4. 4.

e) Target Population
i) Who will this grant serve? Describe your target population and
communities/geographic locations you serve.

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Grant Proposal Application 2017
 ii) How many people will be impacted? Provide a breakdown: number of children,
youth, adults, seniors, etc. Include a detailed list of activities and number of
participants for each activity.
f) Program Outcomes and Evaluation
i) What are the key anticipated outcomes of the program and impact on participants?
ii) How will you know if you have achieved the expected outcomes?
iii) How will progress towards the objectives be tracked and measured?
What is your timeline for achieving your goals? (ex.: 1 day, 3 months, 6 months, 1
year)

3) Program Future
a) Explain how you will support this program after the funding period.

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Grant Proposal Application 2017
II. Proposed Program Budget
1. How much money are you requesting from the AHF Fund in US dollars?

2. Are you currently receiving funding from AHF other than the AHF Grant Fund? If yes, what & how much?

3. Budget Details and Justification: For each item under these categories, please provide a brief description and justify each categorical cost by
project/program period by completing the table below.

Your Amount
PERSONNEL (Line item explanation formula/equation use as applicable. Organizations Requested from TOTAL PERSONNEL
Example: 40 books @ $100 each = $40000) Contribution AHF (US Dollars)
(US Dollars) (US Dollars)

TOTAL, PERSONNEL $
Your TOTAL
Amount
Organizations PROGRAM/OPERATING
PROGRAM/OPERATING EXPENSES Requested from
Contribution (US Dollars)
AHF (US Dollars)
(US Dollars)

TOTAL, PROGRAM/OPERATING EXPENSES $

Your TOTAL
Amount
Organizations INDERECT/OVERHEAD
INDIRECT/OVERHEAD EXPENSES (GOAL 7.5%) Requested from
Contribution (US Dollars)
AHF (US Dollars)
(US Dollars)
$
GRAND TOTAL PROGRAM/PROJECT BUDGET (US Dollars) $ $ $

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Grant Proposal Application 2017
III. Disclosures

1. To help us identify potential conflicts of interest, to the extent reasonably known to you, please identify
any employees or Board directors of your organization who are also employed by AHF or sit on AHFs
Board of directors. Please also identify any of your employees or Board directors who have a family
relationship with any AHF Board director or employee. A family relationship includes parents,
grandparents, children, grandchildren, cousins, spouses, and in-laws.

2. Please identify any Board directors, employees or volunteers of your organization who are government
officials or are immediate family members of government officials.

3. Please identify any criminal investigations or convictions against your organization or any of its Board
directors, executives, or managers in the last ten years.

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Grant Proposal Application 2017