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Identifying Information

Organization

Address 1

Address 2

City / Town

State / Region

ZIP / Postal Code

Country

Continent- Select -AfricaAsiaOceaniaEuropeNorth AmericaSouth America

Map Address (If Different)

Map City / Town (If Different)

Map State / Region (If Different)

Map Zip / Postal Code (If Different)

Map Country (If Different)

Phone

Email

Website

Organization Leader (Name, Title)

Primary Contact’s Name

Primary Contact’s Position

Foundation at a Glance

Year Founded

Mission StatementTo assist in developing open democratic society by means of human rights protection and its realization in all spheres of social life; development of civil initiatives; assistance to Euro integration process

Organization Description- Select -Community FoundationCommunity philanthropy organisationOther non profitOther

Other Description

Approximate Size of the Population Serviced

Total Paid Staff (Full-Time Equivalents)

Total Unpaid Staff (Full-Time Equivalents)

Total Board Members

Financial Information (in U.S. Dollars)

Organization’s Total Income in Last Fiscal Year

Organization’s Gifts Income in Last Fiscal Year

Organization’s Total Expenditures in Last Fiscal Year

Organization’s Grantmaking Budget in Last Fiscal Year

Does Organization Have an Endowment- Select -No and do not intend to build oneNo but intend to build oneYes

Value of Endowment (or Financial Reserves) as of the End of Last Fiscal Year

Change in Financial Status Over Last Three Years- Select -DeclinedStayed about the sameA little improvementSignificant improvement

Priorities and Achievements

Factors that Played a Role in the Origins of Your Organization

Community leadership- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Philanthropic gifts- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Grassroots activism- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Inadequate government services- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Changes in the political environment- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Changes in the economic environment- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Government initiative funding- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Foundation initiative funding- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Bilateral or multilateral initiative funding- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Favorable legal or fiscal policies- Select -Did not answerNo rolePlayed a slight rolePlayed an important rolePlayed a centrally important role

Time Spent Working in Following Areas

Neighborhood- Select -Did not answerNoneVery little timeFair amount of timeLots of time

Locally- Select -Did not answerNoneVery little timeFair amount of timeLots of time

Regionally- Select -Did not answerNoneVery little timeFair amount of timeLots of time

Nationally- Select -Did not answerNoneVery little timeFair amount of timeLots of time

Internationally- Select -Did not answerNoneVery little timeFair amount of timeLots of time

Rate Importance of the Following Functions

Grantmaking- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Having local people as leaders in the organization- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Seeking local donations- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Having a gender balance in the organization- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Board reflective of community diversity- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Building an endowment- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Serving donor needs- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Acting as a fiscal intermediary for the community- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Building inclusion and trust in the community- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Pursuing equity- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Accountability to local people- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Raising money for grantmaking annually- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

Community development- Select -Did not answerN/ANot importantSlightly importantImportant but not centralCentrally important

In the Last Year, Extent to Which Programming and/or Grantmaking Involved Work in the Following Areas

Arts and culture- Select -Did not answerNot at allLittleFair amountLot

Education- Select -Did not answerNot at allLittleFair amountLot

Environment- Select -Did not answerNot at allLittleFair amountLot

Health- Select -Did not answerNot at allLittleFair amountLot

Human and social services- Select -Did not answerNot at allLittleFair amountLot

Human rights- Select -Did not answerNot at allLittleFair amountLot

International relations- Select -Did not answerNot at allLittleFair amountLot

Religion- Select -Did not answerNot at allLittleFair amountLot

Economic development- Select -Did not answerNot at allLittleFair amountLot

Conflict resolution/bridging different parts of the community- Select -Did not answerNot at allLittleFair amountLot

Information technology- Select -Did not answerNot at allLittleFair amountLot

Strengthening local or regional government- Select -Did not answerNot at allLittleFair amountLot

Housing- Select -Did not answerNot at allLittleFair amountLot

Children- Select -Did not answerNot at allLittleFair amountLot

Water- Select -Did not answerNot at allLittleFair amountLot

Alternative energy- Select -Did not answerNot at allLittleFair amountLot

Disaster relief- Select -Did not answerNot at allLittleFair amountLot

Advocacy with authorities- Select -Did not answerNot at allLittleFair amountLot

Job training- Select -Did not answerNot at allLittleFair amountLot

Nongrantmaking Services Offered to Community in Recent Years

Convening for issues of local concern- Select -Did not answerNeverRarelyOccasionallyOften

Promote collaboration between grantees- Select -Did not answerNeverRarelyOccasionallyOften

Promote understanding of public policy- Select -Did not answerNeverRarelyOccasionallyOften

Training/capacity-building for local organizations- Select -Did not answerNeverRarelyOccasionallyOften

Advocacy- Select -Did not answerNeverRarelyOccasionallyOften

Loaned staff- Select -Did not answerNeverRarelyOccasionallyOften

Research- Select -Did not answerNeverRarelyOccasionallyOften

Community needs assessment- Select -Did not answerNeverRarelyOccasionallyOften

Leadership development- Select -Did not answerNeverRarelyOccasionallyOften

Internships- Select -Did not answerNeverRarelyOccasionallyOften

Providing space for local organizations- Select -Did not answerNeverRarelyOccasionallyOften

Access to information technology- Select -Did not answerNeverRarelyOccasionallyOften

Publishing/knowledge sharing- Select -Did not answerNeverRarelyOccasionallyOften

Main Trends Over the Past Year in Geographic Area Served

Poverty- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Crime- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Trust among different sections of the community- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Equitable distribution of resources and services- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Social position of marginalized groups- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Responsiveness of authorities- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Appropriateness of public policies- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Value of community assets- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Quality of the environment- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Number of people and organizations working to change and improve their community- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Levels of innovation and risk taking in addressing community problems- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Networks and links between different parts of the community- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Gender equity- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Charitable giving through the community foundation- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Number of people and organizations involved in philanthropic giving- Select -Did not answerGetting much worseGetting worseNo changeGetting betterGetting much betterN/A

Extent to Which Organization Can Claim Tangible and Measurable Achievements in the Past Three Years

Poverty- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Crime- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Trust among different sections of the community- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Equitable distribution of resources and services- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Social position of marginalized groups- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Responsiveness of authorities- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Appropriateness of public policies- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Value of community assets- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Quality of the environment- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Number of people and organizations working to change and improve their community- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Levels of innovation and risk taking in addressing community problems- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Networks and links between different parts of the community- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Gender equity- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Charitable giving through the community foundation- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Number of people and organizations involved in philanthropic giving- Select -Did not answerDo not work in this sphereWork in the sphere but no measurable achievementA few small achievementsSome important achievementsMuch achievement

Active Partnerships

Formal community associations and groups- Select -Did not answerN/ANot at allLittleLot

Informal associations of citizens- Select -Did not answerN/ANot at allLittleLot

Non-governmental organizations- Select -Did not answerN/ANot at allLittleLot

Local government- Select -Did not answerN/ANot at allLittleLot

National government- Select -Did not answerN/ANot at allLittleLot

Universities- Select -Did not answerN/ANot at allLittleLot

Schools- Select -Did not answerN/ANot at allLittleLot

Businesses- Select -Did not answerN/ANot at allLittleLot

Partnerships and External Aid

Other Institutions Helpful to Our Work

National association of grantmakers- Select -Did not answerN/AVery unhelpfulUnhelpfulNeither helpful or unhelpfulHelpfulVery helpful

Regional association of grantmakers- Select -Did not answerN/AVery unhelpfulUnhelpfulNeither helpful or unhelpfulHelpfulVery helpful

Global Fund for Community Foundations- Select -Did not answerN/AVery unhelpfulUnhelpfulNeither helpful or unhelpfulHelpfulVery helpful

Particular foundation- Select -Did not answerN/AVery unhelpfulUnhelpfulNeither helpful or unhelpfulHelpfulVery helpful

Other organization- Select -Did not answerN/AVery unhelpfulUnhelpfulNeither helpful or unhelpfulHelpfulVery helpful

Other Institution

Involvement of Local People

Regularly survey local people about our programs- Select -Did not answerNoYes

Local people are engaged in the delivery of our work- Select -Did not answerNoYes

Local people control what our organization does- Select -Did not answerNoYes

Have local people represented on our board- Select -Did not answerNoYes

Have regular sessions where local people advise us what our programs should do- Select -Did not answerNoYes

Actively engage local people as volunteers- Select -Did not answerNoYes

All of our board is composed of local people- Select -Did not answerNoYes

Account to local people about our successes and failures each year- Select -Did not answerNoYes

Assistance in Overcoming Main Difficulties Faced in Developing Organization Further

Increased funding- Select -Did not answerN/AVery unimportantUnimportantNeither important nor unimportantImportantVery important

Better legal or fiscal environment- Select -Did not answerN/AVery unimportantUnimportantNeither important nor unimportantImportantVery important

More volunteers- Select -Did not answerN/AVery unimportantUnimportantNeither important nor unimportantImportantVery important

Access to advice or technical assistance- Select -Did not answerN/AVery unimportantUnimportantNeither important nor unimportantImportantVery important

Better local culture of giving- Select -Did not answerN/AVery unimportantUnimportantNeither important nor unimportantImportantVery important

Stronger civil society- Select -Did not answerN/AVery unimportantUnimportantNeither important nor unimportantImportantVery important

More responsive authorities- Select -Did not answerN/AVery unimportantUnimportantNeither important nor unimportantImportantVery important

Other

Most Meaningful Change

Most Meaningful Change that Organization Has Helped to Bring About in the Last Three YearsIn collaboration with district and local authorities and public-private partnerships in the local community, we transformed a rural cultural institution in the village of Tupychiv into a local activity center. The center supports children’s clubs and organizes educational activities for local civic initiative groups.

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