United Way of Weld County Community Impact Partner* Application
*the term “Partner” does not and will not imply a legal connection between United Way of Weld County and the applicant organization
Legal Name of Organization
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DBA (if applicable)
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Mailing Address
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City
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State
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Zip Code
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Physical address if it is different and not confidential
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Phone
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Fax
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Employer Identification Number (EIN)
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Website
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Organization Email Address
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Name of CEO or Executive Director
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Phone
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Email
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Other Contact Person & Title (if other than the CEO or executive director)
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Phone
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Email
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Organization Information
Year Founded
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Mission Statement
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Tax Exempt Status
Required
If you chose "using a fiscal agent/fiscal sponsor" or "other," please describe.
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Provide a 50-75 word description of the agency and its programs.
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Which agency program will be populated to the Thriving Weld Dashboard and reported on at least quarterly? After becoming a Community Impact Partner, agencies may populate multiple programs to the Thriving Weld Dashboard.
Please send a completed logic model for this program to serita@unitedway-weld.org. To download the logic model template, click here: https://goo.gl/thuLXD
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Better Business Bureau Charity Accreditation is mandatory for Community Impact Partners. Does the agency currently have Better Business Bureau Charity Accreditation?
If No, what month/year will the agency begin the accreditation process?
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This application information is true and correct to the best of my knowledge.
Please enter the first and last names of the agency CEO/Executive Director or Board of Directors Chair below to sign your agreement.
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