2023/2024 Community Impact Funding Request Application Due Date April 5th by midnight.

List an email below to receive a copy of your application responses.

Sign in to Google to save your progress. Learn more
Email *

Application Deadline & Instructions:

Deadline:  Applications are due by midnight on April 5th, 2023. Absolutely no late applications will be accepted.  Completed applications should be submitted electronically on this form OR  e-mailed to: finance@unitedwayofwilson.org

  1. SUPPORTING DOCUMENTS REQUIRED:
  2. Please provide one copy of each of the following. If any of the following are not completed or included, the committee reserves the right to deny acceptance of the application. These items should be scanned & e-mailed to finance@unitedwayofwilson.org prior to midnight on April 5th, 2023. If your file is too large to email please deliver your documents to the United Way office: 316 Douglas Street.
  3. Current audit with copy of management letter and IRS form 990 (must be within 18 months of your recent year end)
  4. Current board member list  with email addresses
  5. Profit and Loss Statement for Jan 1, 2022 through Dec 31, 2022
  6. Current Balance Sheet 
  7. Budget for organization - United Way will send template under separate email (estimates are acceptable) 
  8. Program demographics - United Way will send template under separate email
  9. Other supported documents as requested by the Community Impact Committee 

Organization Information

Please complete the following information about your organization & the program for which you are requesting funding:

Name of organization applying for funding:

*

Program physical address (where we would go for a site visit):

*

Name of Executive Director:

*

Email for Executive Director:

*

Phone number for Executive Director:

*

What is your organizational mission statement?

*

Is your organization a 501(c)3 in good standing?

*
Required

Date of your most recent audit?

*
MM
/
DD
/
YYYY

Date of your most recent 990?

*
MM
/
DD
/
YYYY

Current number of board members?

*

Number of official board meetings held within the last 12 months?

*

Did you have at least 50% attendance at each board meeting during the last 12 months?

*

Program Name

*

Total program cost for which 2023/2024 funding is requested.

*

Total amount requesting from United Way of Wilson County, Inc. for the 2023/2024 allocation distribution.

*

Amount of allocation awarded from United Way of Wilson County, Inc. for the 2022/2023 allocation distribution. 

*

Agreements:  

By submitting this application, our organization agrees to the following:

We agree to participate in a United Way Campaign.  

We agree to attend director meetings and provide quarterly reports. 

We agree to help with fundraising activities, if asked.

We agree to site visits. 

We agree to promote the United Way in a positive manner and participate in United Way activities as often as possible.

We agree to be available to make a presentation to accompany application.  

We understand that United Way allocations will be discontinued if our program is not providing services as explained in our funding request.

Program Information

United Way of Wilson County funds programs at organizations with experience in education, financial stability and health working to reduce the cycle of poverty.

Give a brief overview of the program in which you are requesting funding:

*

In regard to your PROGRAM, not organization, please choose the United Way pillar it falls under:

*
Required

Describe how your program meets the United Way's funding pillar chosen above.


*

What is the specific need addressed by this program?


*

How was the need identified within the community and what data sources verified it? Please answer this with current data and the source of the data. 


*

Statement of Impact: Provide an Impact Statement on how United Way of Wilson County, Inc. funding will help your clients. Example: $20 a month provided a low income child with 6 weeks of counseling, etc.

*

What specifically will United Way of Wilson County, Inc. funding be used for? 

*

Please provide an explanation of how your program impacts those in the community in the areas of education, financial stability or health:

*

What will United Way of Wilson County, Inc. funding allow you to do what otherwise could not be done? Why is this important?

*

Is this program sustainable? Give a brief overview of your long term plan.

*

Will the funds provided by United Way of Wilson County, Inc. be matched by another agency, program or foundation? If yes, by how much?

*

How do you collaborate with other entities to provide these services?*

*

Identify measurements that will be used to determine outcomes.  What is the expected measurable impact of the program?

*

Describe how data will be collected for outcome measurement. 

*

Does this program have any confirmed partners (organizations, entities or individuals who have already committed to assisting with the program) or potential partners (those approached but not yet confirmed)? If so, please list all concerned:

*

How many of the program population served do you project will be at poverty level or below? If you have completed this program in the past, how many served were at poverty level or below?

*

How many clients do you project will be served by this program during the funding period?

*
Provide an example of program success from your program from the 2022/2023 United Way allocation and include the number served in your program. *
What percentage of your budget is your request for funding from the United Way? *
Is this program sustainable without United Way funding?  If your answer is no, please describe efforts planned to become more self-sustaining. *
Provide a list of fundraisers you did in the last 12 months. *
If the above is a n/a response, please list any new grants that you received during the 2022/2023 allocation period. *
If the above is n/a for fundraisers and grants please explain any board approved recommendations made to help your agency offset funding reductions from your recent United Way allocation. *
Would your agency be interested in a 2-year grant cycle versus a 1 year cycle?  Allocated funds would be the same for years 1 and 2 if recommended by the Community Impact Committee.   *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy