2026 ZERO Local Grants Please ensure that you have reviewed the Community Grant website, including its eligibility requirements and restrictions, before completing this application. Important: Progress is not saved automatically. Please complete this form in a single session. We encourage you to find the complete list of questions in the Community Grant Packet and draft your responses in a separate file. Your application and all information submitted will be treated as strictly confidential and used solely for the purpose of evaluating your grant request. About the Organization: Organization Legal Name Organization DBA or AKA, if applicable Organization Physical Address Street City/Town State/Province - None -AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPuerto RicoPalauVirgin IslandsArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces PacificBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Organization Mailing Address Street City/Town State/Province - None -AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPuerto RicoPalauVirgin IslandsArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces PacificBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Organization Website Organization Mission Is your organization recognized as tax-exempt under Section 501 of the Internal Revenue Code Yes No Unfortunately, this grant opportunity is open only to organizations with 501(c)(3) tax-exempt status. If you select “No,” the rest of the form will be disabled. Please indicate your tax-exempt designation 501(c)(3) - Charitable Organization 501(c)(4) - Civic Leagues and Social Welfare Organizations 501(c)(6) - Business Leagues, Chamber of Commerce 501(c)(7) - Social and Recreational Clubs 501(c)(8)- Fraternal Beneficiary Societies 501(c)(10)- Domestic Fraternal Beneficiary Societies 501(c)(19) - Veterans Organization 501d- Religious and Apostolic Associations Other… Enter other… Please provide your organization’s Employer Identification Number (EIN): Have you previously received funding or had a partnership with ZERO Prostate Cancer? Previous funding history does not affect current eligibility. All applications will be evaluated based on current criteria. Yes No Please add short description. About the Applicant: Name First Last title Email Address Phone Number Mailing Address Street City/Town State/Province - None -AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPuerto RicoPalauVirgin IslandsArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces PacificBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Would you like to add a secondary contact to this application? Yes No Secondary Contact First Last Secondary Contact Title Secondary Contact Email Address Secondary Contact Phone Number Grant Application: ZERO Prostate Cancer funds requests based on alignment with our mission and strategic community investment priorities outlined below. Please indicate which priority aligns with your request. How does your organization and this project align with ZERO Prostate Cancer’s mission and funding priorities? Priority Alignment ( Select the one priority that aligns with your grant-funded activity) Community Event Awareness, Outreach, & Education Screening & Early Detection Navigation Research Request Type: Is this a one-time event or ongoing programming One-time event Ongoing Programming Requested Grant Amount: Must be less than $10,000 $ Please provide a bulleted list that details how grant funds will be utilized Example: $2,000 for screening/clinical partner, $500 for education material, etc. Please provide details on any additional financial and in-kind contributions that will support this program, including those from your organization and other funding sources. Event/Program Details Proposed Program or Event Name Program/Event Description: Please explain your program activities, location, start/end dates, primary beneficiaries (including relevant community demographics such as race, socioeconomic level, veteran status, etc.), and any additional relevant information. Be as specific as possible. Example: we plan to host a single community screening event in September 2026 for the defined community. We anticipate serving 300 local community members and connecting them to a local federally qualified health clinic or primary care facility. Please note any collaborating organizations or community partners who will be engaged in this program. How many individuals will be served by this program/event? What is the projected impact of this program/event? Example: 150 individuals will receive free screenings, 300 community members will receive education on available resources in our community. How will you measure the success and impact of this program? List any specific metrics you anticipate collecting. Example: # of referrals made to primary care or medical homes. Does your program address a social determinant of health domain? Yes No ▶ What are social determinants of health? Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Please select Economic Stability Education Access and Quality Health Care Access and Quality Neighborhood and Built Environment Social and Community Context How does this program address health disparities in prostate cancer education and awareness, screening, treatment, or outcomes?
