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Applying Organization

Organization Name

Street Address



Zip Code


Executive Sponsor





Grant Contact Person





Organization Overview & Goals
Please tell us about your organization

What is your mission?

What is your annual budget range?

How many clients do you serve annually?

What types of social services do you provide?

What percent of your funding comes from federal, state, and local government contracts and private funding? Please specify the percent by type?

% Federal

% State

% Local Government Contracts

% Private Funding

Are you affiliated with a local or national member organization? If so, what are their name(s)?

What are the short term and long term goals your organization has around accessing and using data?

Based on your high level understanding of IBM SafetyNet, briefly describe how you hope the solution will provide value to your organization.

Reporting & Data

What challenges do you face related to contract, program, and client data collection?

What challenges do you face related to contract, program, and client data reporting and analysis?

Do you have established outcome measurements for the programs you deliver?

Please provide an example of the outcomes you measure for one of your programs/departments?

What is your organization’s ability to track and report on these outcome measurements in a common, coordinated, and consistent basis?

Technical Environment

Do you currently have one enterprise wide system across your organization that collects contract, program, and client data? If yes, is SafetyNet meant to replace or supplement the existing application(s) and why?

What is the technology and business proficiency across your organization in each of the following:

Prior experience with online tools, data entry, data migration and tool configuration:

Project management skills in-house:

Data integrity strategy and compliance monitoring:

IT resources/team available:

Describe your current technology/system environment including high level number of computers, average age of computers, software used (including office tools such as word and excel, version of internet explorer used etc).

Organizational Capacity

What would be the optimal time frame for your organization to start the grant?

Do you have executive leadership commitment to support this grant?

Do you have a individual(s) available who can serve as the IBM SafetyNet liaison and/or coordinator who will be responsible for managing the deployment of the application and associated organizational change management?