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Letter of Intent Form

Letter of Intent (LOI) online applications for 2025 projects will be accepted April 29-June 3, 2024.

Questions about the 2025 grants process: chuber@donatelifewisconsin.org.

Begin the form below — all components are required.

At the end of the form, there is an option to save your progress and continue later. A link to return to your form will be provided. The link is good for 30 days; be sure to save it for your records.

You may also wish to print the completed form within your browser menu before submitting it.

Organization
Organization Legal Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Website*
EIN*
Project Staff Contact
First Name*
Last Name*
Title*
Email Address*
Phone Number*
Project Information
Project Name*
Type of Project*
Select one.
- Promote donation of organs and tissue
- Advance patient services involving organ and tissue transplants
- Promote organ and tissue research
Project Focus*
Check all that apply.
- Unmet need: increasing donor registration or availability of more donated organs/tissues for transplant
- Specific demographic, age or professional group
- Unique geographic location (county, region or tribal area) of Wisconsin
- Transformational change in professional/clinical practices, policy or systems
Need (600 characters or 150 words max)*
What problem is the project intended to address?
Data/Studies Used to Determine Project Focus/Need*
Project Overview*
Must include description of project, capacity of organization and internal/external partners to accomplish project. (3,000 characters or 500 words max)
Anticipated Project Outcomes*
Describe up to three outcomes.
Project Impact Statements (Answer one or both.)
How will this project increase the number of individuals who register to become organ, eye and tissue donors?
Project Impact Statement (Answer one or both.)
How will this project increase the number of donated organs/tissues available for transplantation?
Funding Request*
($10,000-50,000)
Attestation
All boxes must be checked before the form can be submitted. The undersigned certifies that:
*
- The individual providing supervision of the Project Staff Contact has given approval to submit this project/Letter of Intent.
*
- The individual or department responsible for financial reporting/financial oversight of grant projects is aware of this project submission.
*
- The project can be completed between January 1 and December 31, 2025 – no exceptions.
*
- The applicant organization has the ability to begin the project on or shortly after January 1, with or without a signed agreement.
*
- The applicant organization is exempt from taxation under section 501(a) of the Internal Revenue Code.
*
- The applicant organization’s Federal tax exemption determination has not been revoked and the present operation of the organization and its current sources of support are consistent with the organization’s continuing tax-exempt classification as set forth in such Determination Letter.
Certification*
I certify that the Attestation Statements above are accurate and true.
Name of Individual*
Job Title*
Email*
Date*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Save Progress and Continue Later

Grants

Letter of Intent Form

Organization

Project Staff Contact

Project Information

Attestation