Funded Partner Progress Report Form 2015-2016
Due: January 15th, 2016


*Please note you cannot save your application to complete at a later date. We recommend writing your answers in Word first and then copying to this form when you are ready to submit.

Organization Information
Organization Name *
Your answer
Contact Name *
Your answer
E-mail *
Your answer
Street Address *
Your answer
City, Province *
Your answer
Postal Code *
Your answer
Mailing Street Address
Your answer
Mailing City, Province
Your answer
Mailing Postal Code
Your answer
Did you receive a United Way Day of Caring in 2015? *
Did you host a United Way Seeing is Believing Tour at your organization in 2015? *
Did you speak on behalf of United Way during their fundraising campaign at a workplace in 2015? *
Did you receive Board Development from United Way in 2015?
Did you participate in any United Way workshops or training in 2015? *
Which workshops did you attend?
Your answer
Did you volunteer for an event for United Way in 2015? *
Program Information
1. Name of program/service/organization outlined in Investment Agreement: *
Your answer
2. Expected outcomes of the investment in the program/service/organization as outlined in the Investment Agreement: From poverty to possibility
All that kids can be
Strong communities
3. Results or progress on stated outcomes above realized to date: *
Your answer
4. Measurements used to track progress on expected outcomes to date: *
Required
5. Simplified breakdown and explanation of investment dollars. Ex. 30% to personnel, 20% to food, 50% to overhead: *
Your answer
6. Challenges encountered with this program/service/organization (shortages, qualifications, unintended outcomes): *
Your answer
7. Recommendations for adaptations or enhancements to this program/service/ organization: *
Your answer
8. Number of unique people served per year related to the funding - whole program or organization depending on type of funding: *
Your answer
9. Total people served per year related to the funding - whole program or organization depending on type of funding: *
Your answer
10. Demographics served: Age (check all that apply) *
Required
Gender served (check all that apply) *
Required
Special Needs served (check all that apply) *
Required
Populations served *
Required
Your Stories Inspire Us
Do you have a story to tell? Share your story about how your program has changed someone’s life. Your story can inspire others to give to their community and make a difference. Because these stories are so valuable in our efforts to raise resources to support non-profit organizations, this portion of the report is required. *If you are filling out this form on behalf of someone else, please tell the story in the first person as if it were your own but remember to obtain written permission prior to this.
Where will your story be highlighted?
Your stories and photos will be used in our communications materials, including our website and our social media channels: Facebook, Twitter etc. We thank everybody in advance for their stories and will highlight as many as possible. In some cases, we will contact you to explore your story further and to discuss building it into a longer web feature or a video.
Please tell us a story of impact about a client, your program or organization *
keep names and identities confidential
Your answer
*Submit information by January 15th, 2016
Photos related to funding (please ensure photo release has been obtained
Please email high resolution photos to communityimpact@unitedwaytnc.ca with subject line Progress Report story: organization name.
Thank you!
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