Application to become a Participating Member Agency of United Way
Each year area non-profit organizations providing human services are invited to apply for funding from the United Way of the Mark Twain Area. Agencies must provide programs and support that focus around education, financial stability, and healthy lives. Applications are reviewed by the Allocation Committee for consideration of membership and funding. Applications for funding and all documents are required to be completed by March 29th. For questions call 573-221-2761.
Agency Name *
Agency Director *
Director E-mail *
Agency Address *
City, St, Zip *
Agency Phone Number *
Website *
EIN *
Application Contact Name *
Application Contact E-mail Address *
Applicant's Phone Number *
I certify I have the authority to submit this application on behalf of the organization *
Required
Share the organization's mission and vision statements. *
Provide a 25 word summary of your agency (that can be used for promotional purposes). *
How many dollars are you applying for from the United Way of the Mark Twain Area? *
Are you currently receiving dollars from the United Way of the Mark Twain Area? *
Have you ever received dollars from the United Way of the Mark Twain Area? *
Which United Way focus area(s) does your organization's work align to? *
Required
Give a brief overview of the program(s) your organization implements. *
What program/project are you requesting United Way dollars for (can simply say "General Operating Costs")?
Which United Way focus area(s) does this program align to? *
Required
Explain how United Way funding would be utilized and the details of that program. *
What community need would United Way funding work to address? How does the program work to address that need? Include community statistics and data that shows the need for the program/evidence the program will work to address that need. *
How will United Way funding empower individuals to achieve their potential through education, financial stability, and/or healthy lives? *
Describe the demographic makeup of the clients you serve with this program. *
Please share a success story from the program you are requesting dollars from the United Way to fund and/or a program United Way dollars were used to fund last year. By sharing this story, it can be used in United Way promotions (please leave out names as needed because of this).
Dollars from the United Way of the Mark Twain Area can ONLY be used to support programs in Marion, Monroe, Ralls, Lewis, and Shelby Counties in Missouri. If you serve additional counties, how can you prove dollars are only used to support the work of these counties? *
What other revenue streams are utilized to support the program you are applying to the United Way to receive funding for? *
Explain any collaborations with other agencies. *
Number of Individuals Served - Form found on Website
Organization Budget - form found on website.
Program/Project Budget - form found on website.
IRS 990
Federal IRS 501(c)3 Tax Exempt Certification
State IRS 501(c)3 Tax Exempt Certification
For budgets over $100,000 please upload your most recent fiscal year's audit (or bring one to the United Way Office)
For budgets of $20,000-$100,000 please upload a Compilation Report prepared by a CPA (or bring a copy to the United Way Office if no full audit)
For budgets under $20,000 please upload most recent approved financial statement
Board Member Listing - form found on website
Organization's most recent Annual Report (if applicable)
Upload Agency's Bylaws
Signed Counter-Terrorism Compliance - form from website
Signed Agency Agreement - form from website
Misc. Other Documents
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