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Program/Service Information 1. Program/Service Name 2. Number of years the program/service you are applying for has been in operation. 3. If your organization is submitting two Waiwai Grant applications on behalf of its own programs/services, please rank your proposals in order of priority for funding. • Applications submitted as a nonprofit fiscal sponsor do not count toward your organization's two- application limit and do not need to be ranked. Program/Service Name Priority#1 Priority#2 4. For the program/service for which you are applying, do you currently have or anticipate having any other contracts/agreements with any other department of the County of Hawaii during the fiscal year of this grant cycle (July 1, 2025 - June 30, 2026)? o Yes/No 5. If you answered "Yes" to the previous question,please tell us with what department and briefly describe the contract/agreement deliverables. • To be completed if you answered"Yes"to question number 4. 6. Have you previously applied for and received a County Nonprofit Grant Award within the last 3 years? o Yes/No • If"Yes",please list grant awards for the last 3 years. FY 22-23 FY 23-24 FY 24-25 Program/Service Name Amount of Grant Award 7. Select all areas of Hawaii Island where the program/service will be administered, delivered, and implemented. o Puna, South Hilo,North Hilo, Hamakua,North Kohala, South Kohala,North Kona, South Kona, Ka'u. • Select all that apply. 8. If multiple boxes were checked in the previous question,please briefly describe your capacity and plan to outreach to those geographic areas. 9. Identify the age group of the target audience(s) the program/service will serve. o Infancy (0-3), Play Age (3-5), School Age (6-11), Adolescence (12-17), Young Adulthood(18-39), Middle Adulthood(40-59), Kupuna(60+). • Select all that apply. 10. Identify the primary services or activities to be provided. o Educational concerns,Needs of the poor, Youth, Victims of Crimes,Public health and welfare of the people and the environment, Culture and the arts, Victims of Health or Social Crises, Aged, Physical/Emotional Disabilities. • Select all that apply. 11. Identify the amount of funds you are applying for. Must be equivalent to or less than your estimated expenditures. Page 4 of 10