First name *
Last name *
Applicant Information
Phone/Mobile *
Current Fellow or Alumni? *
— select —
Current Fellow
ASF Alumni
Fellowship Cohort Year *
University / Organization (if applicable) *
Request Information
Amount Requested (Maximum request: $2,000) *
Opportunity Category
Opportunity Category *
— select —
Leadership Development
Professional Certification
Conference Registration
Travel
Publication Fees
Community Engagement
Project Expansion
Equipment / Supplies
Partnership Development
Other
If selecting other, please describe: *
Opportunity Description
Describe the opportunity you are requesting funding for. (250-500 words) *
Why is this opportunity time-sensitive? *
How will this funding strengthen your leadership, project, or community impact? *
How does this opportunity align with the Albert Schweitzer Fellowship's mission of improving health and well-being through service and leadership? *
Expected Outcomes
Describe the specific results you expect to achieve if your request is funded. Include 2–3 measurable outcomes that demonstrate how this opportunity will strengthen your leadership, enhance your project, or increase your community impact.
Outcome 1 *
Outcome 2 *
Outcome 3 *
Proposed Budget
Please provide a brief breakdown of how you plan to use the requested funds. Include each anticipated expense and its estimated cost. Budget requests should be reasonable, directly related to the proposed opportunity, and reflect only the amount needed to achieve the intended impact.
Budget Items *
List one expense per line with its estimated cost (for example: Program supplies — $150).
Total Requested *
Have you applied for or received funding from another source for this opportunity? *
— select —
Yes
No
If yes, please explain. *
Timeline
Provide the anticipated timeline for this opportunity, including key dates for when the activity will occur, how long it will last, and when you expect to complete it. This helps ASF understand the urgency of your request and the expected timeframe for impact.
When will the opportunity occur? *
When will funds be spent? *
When will activities be completed? *
Reporting Requirements
To help us measure the impact of the ASF Catalyst Fund and share the stories of those we support, grant recipients will be asked to complete a few simple reporting requirements after their funded opportunity is complete. Please review and acknowledge the commitments below.
If awarded an ASF Catalyst Fund grant, I agree to: *
Please check every commitment to acknowledge it.
Applicant Certification
I have reviewed the information above and certify that the information provided in this application is true and accurate. I agree to comply with all ASF Catalyst Fund requirements if funding is awarded. *
Date *
“Save & continue later” gives you a private link to finish your application any time before the deadline.