denniswright
carpediem2574
2017-2018_grant_application.docx
United Way of Southwest Oklahoma
1116 SW A Avenue/P.O. Box 66
Lawton, OK 73502
580-355-0218
2017-2018 Funding Cycle
RFP
Grant Funding Application
Issue Date: January 3, 2017
Submission Deadline: 5PM February 16, 2017
Application Scores are worth 75% and Program Site Visits are worth 25% of the total points available for those that apply for funding
United Way of Southwest Oklahoma Grant for 2016-2017 Funding Cycle
Program Category:
Please select only one category for each program.
|_|Education –Programs in this category promote learning in an effort to support children, both in and out of the classroom. Programs designed to help children learn and grow should be designated in this category.
|_| Income Stability –Programs in this category promote the development of financial and employment skills for adults that are necessary to achieve stability, safe housing, and overall security for them and/or their families. Programs designed to rehouse families, provide financial assistance for payment of bills/deposits/rent, provide legal assistance, provide job training/employment assistance, and/or provide financial education should be designated in this category.
|_|Health & Safety –Programs in this category promote safe and healthy lives by providing access to affordable healthcare, emergency shelters, counseling, rehabilitation services, access to food, and basic needs. Programs designed to provide food, counseling, protection/advocacy efforts, shelter, healthcare, rehabilitation, and basic needs should be designated in this category.
Section 1: Organization Overview
Program name: Click here to enter text.
Organization Submitting Request: Click here to enter text.
CEO/Organization Director: Click here to enter text.
Program Director: Click here to enter text.
Program Mailing Address: Click here to enter text.
City, State, Zip Code: Click here to enter text.
Program Physical Address: Click here to enter text.
Telephone: Click here to enter text. Fax: Click here to enter text.
Email of Organization Director: Click here to enter text.
Email of Program Director: Click here to enter text.
Website: Click here to enter text.
Contact for this Program Proposal (Name/Title): Click here to enter text.
Phone: Click here to enter text. Email: Click here to enter text.
Amount Requested for this program from United Way of Southwest Oklahoma for 2017-2018: $ Click here to enter text.
Is this a new program request for United Way of Southwest Oklahoma? |_| Yes |_| No
Section 2: Program Overview
Number of years the organization has been in operation: Click here to enter text.
Number of years this program has been in operation: Click here to enter text.
Number of full-time program staff for proposed program: Click here to enter text.
Number of part-time program staff for proposed program: Click here to enter text.
Number of volunteer program staff for proposed program: Click here to enter text.
How many participants were served by this program last year: Click here to enter text.
How many participants served by this program last year were low income: Click here to enter text.
How many participants are projected to be served by this program this year: Click here to enter text.
How many participants that are projected to be served by this program this year will be low income: Click here to enter text.
Was this program funded by UWSWOK in FY 2016-2017? |_| Yes |_| No
If yes, how much did your organization receive for this program? Click here to enter text.
Proposed general operating budget for upcoming fiscal year (FY 2017-2018): Click here to enter text.
Additional funding sources, and amounts, for general operating: Click here to enter text.
Section 3: Explanation of Board Designated Reserves
Board Designated reserves are funds which are not donor restricted. Please Note: As of January 1, 1988, each organization shall be required to make full disclosure of all funds from every source. Failure to do so will exclude an organization and their programs from consideration in the UWSWOK grant allocation process.
Name of Board Designated Reserve #1: Click here to enter text.
Date of Board meeting at which designation was made: Click here to enter text.
Source of funds: Click here to enter text.
Designated purpose: Click here to enter text.
Are the investment earnings available for current unrestricted expenses: |_| Yes |_| No
If yes, what amount: Click here to enter text.
Date when board designation became effective: Click here to enter text.
Date when board designation expires: Click here to enter text.
Name of Board Designated Reserve #2: Click here to enter text.
Date of Board meeting at which designation was made: Click here to enter text.
Source of funds: Click here to enter text.
Designated purpose: Click here to enter text.
Are the investment earnings available for current unrestricted expenses: |_| Yes |_| No
If yes, what amount: Click here to enter text.
Date when board designation became effective: Click here to enter text.
Date when board designation expires: Click here to enter text.
Name of Board Designated Reserve #3: Click here to enter text.
Date of Board meeting at which designation was made: Click here to enter text.
Source of funds: Click here to enter text.
Designated purpose: Click here to enter text.
Are the investment earnings available for current unrestricted expenses: |_| Yes |_| No
If yes, what amount: Click here to enter text.
Date when board designation became effective: Click here to enter text.
Date when board designation expires: Click here to enter text.
Name of Board Designated Reserve #4: Click here to enter text.
Date of Board meeting at which designation was made: Click here to enter text.
Source of funds: Click here to enter text.
Designated purpose: Click here to enter text.
Are the investment earnings available for current unrestricted expenses: |_| Yes |_| No
If yes, what amount: Click here to enter text.
Date when board designation became effective: Click here to enter text.
Date when board designation expires: Click here to enter text.
Section 4: Explanation of Restricted Funds
Restricted Funds are funds which are donor restricted- excludes Board restricted/designated funds. Please note: As of January 1, 1988, each organization shall be required to make full disclosure of all funds from every source. Failure to do so will exclude an organization from consideration in the UWSWOK grant allocation process.
Name of Restricted Fund #1: Click here to enter text.
Restricted by: Click here to enter text.
Source of funds: Click here to enter text.
Purpose for which restricted: Click here to enter text.
Are the investment earnings available for current unrestricted expense? |_| Yes |_| No
If yes, what amount? Click here to enter text.
Date when restriction became effective: Click here to enter text.
Date when restriction expires: Click here to enter text.
Name of Restricted Fund #2: Click here to enter text.
Restricted by: Click here to enter text.
Source of funds: Click here to enter text.
Purpose for which restricted: Click here to enter text.
Are the investment earnings available for current unrestricted expense? |_| Yes |_| No
If yes, what amount? Click here to enter text.
Date when restriction became effective: Click here to enter text.
Date when restriction expires: Click here to enter text.
Name of Restricted Fund #3: Click here to enter text.
Restricted by: Click here to enter text.
Source of funds: Click here to enter text.
Purpose for which restricted: Click here to enter text.
Are the investment earnings available for current unrestricted expense? |_| Yes |_| No
If yes, what amount? Click here to enter text.
Date when restriction became effective: Click here to enter text.
Date when restriction expires: Click here to enter text.
Name of Restricted Fund #4: Click here to enter text.
Restricted by: Click here to enter text.
Source of funds: Click here to enter text.
Purpose for which restricted: Click here to enter text.
Are the investment earnings available for current unrestricted expense? |_| Yes |_| No
If yes, what amount? Click here to enter text.
Date when restriction became effective: Click here to enter text.
Date when restriction expires: Click here to enter text.
Name of Restricted Fund #5: Click here to enter text.
Restricted by: Click here to enter text.
Source of funds: Click here to enter text.
Purpose for which restricted: Click here to enter text.
Are the investment earnings available for current unrestricted expense? |_| Yes |_| No
If yes, what amount? Click here to enter text.
Date when restriction became effective: Click here to enter text.
Date when restriction expires: Click here to enter text.
Name of Restricted Fund #6: Click here to enter text.
Restricted by: Click here to enter text.
Source of funds: Click here to enter text.
Purpose for which restricted: Click here to enter text.
Are the investment earnings available for current unrestricted expense? |_| Yes |_| No
If yes, what amount? Click here to enter text.
Date when restriction became effective: Click here to enter text.
Date when restriction expires: Click here to enter text.
Section 5: Narrative Outline
Provide the following information in narrative form in the order that it is presented below. The responses must be typed, in 12 point font, submitted as an attached document with the application, and limited to no more than 5 pages. Please note that required completed forms do not count against page totals.
Organization Information: Maximum 4 Points Possible
1. Provide a brief description of the organization’s mission and goals. Provide a brief description of the mission and goals of the program for which your organization is requesting funding.
2. Provide a brief description of the organization’s capacity and relevant experience in facilitating the proposed program funding request.
3. Provide a brief description of your organization’s Board of Directors/ volunteer leadership/governing body structure
a. How do they demonstrate an active role in the organization?
b. What percentage of Board Members make an annual financial contribution to the organization?
c. What is the total amount of funding Board Members make annually in financial contributions to the organization?
4. Provide a brief description of the organization’s use of UWSWOK partnership in marketing materials and in the media.
Program Description: Maximum 10 Points Possible
1. Provide a description of the program including:
a. Program activities
b. Population served
c. Number of people who benefited from the program last year, broken down by: numbers served in each county; age (0-5, 6-12, 13-21, 22-54, 55-64, 65+), sex, and ethnicity (American Indian, Asian, Black, Hispanic, Pacific Islander, & White).
d. Number of people projected to benefit from the program this year, broken down by: numbers served in each county; age (0-5, 6-12, 13-21, 22-54, 55-64, 65+), sex, and ethnicity (American Indian, Asian, Black, Hispanic, Pacific Islander, & White).
e. Collaborations with other organizations, programs, or other UWSWOK partners.
2. Explain the significance/importance of the program
3. Share the program’s significant accomplishments over the last few years. If this is a new program, what experience or expertise does the staff have to address the needs of these clients?
4. Are there similar programs in Southwest Oklahoma? If so, how is your program unique/different?
5. Discuss program strategies, including prevention and intervention tactics used
6. How will the program ensure access to services for those most in need?
7. If awarded, how will UWSWOK funding be used? What specific aspects (line items) of the program would UWSWOK funding be used for?
8. If awarded, at a lower than requested amount what program changes will the organization make? What aspects of the program would be changed or deleted as a result of less than requested funding amount? Be specific give examples of what the program would do if it only received 80% and 70% of funding requested.
9. Please complete form titled Partnership Support of UWSWOK
10. Please complete form titled Success Stories
Program Outcomes: Maximum 10 Points Possible
1. Please complete form titled Outcomes
2. Who manages the outcome measurement process?
3. Describe methods used to collect and analyze data.
4. How often will data be collected?
5. How is your program making positive progress towards its goals through measurable outcomes?
Program Effectiveness: Maximum 10 Points Possible
1. Describe research or best practices used to insure program effectiveness. If applicable, reference your outcome measurements that have been collected to this point.
2. Please complete form titled Measurement of Progress Towards Goals
3. Please complete form titled Goals for 2016-2017
4. How do you know your program is effectively working and meeting its goals?
5. If applicable, describe challenges or barriers that have affected your program and how they have been addressed.
Program Budget: Maximum 10 Points Possible
1. Complete form titled Program Budget Sheet
Organization Financials: Maximum 10 Points Possible
1. Attach an Audited Financial Statement (for organizations with annual income of $100,000 or more) must cover the fiscal period ending not more than 18 months prior to June 30, 2016 (i.e. audit must be dated December 2014 or after)
2. Attach most recent IRS 990, including Schedule A or 990 EZ (State and Federal applications require additional paperwork for 990)
3. Attach a Current Budget for the entire organization including expected revenue and expense
4. Attach a Year to Date Financial Statement (balance sheet, income, and expense statement) for entire organization
5. Please complete form titled Supplementary Fundraising Activities
6. Please complete form titled Community Impact Calculator
7. Please complete form titled Community Impact Equation
Partnership Support of UWSWOK (to be completed as part of the Program Effectiveness portion of the Narrative)
Participation in UWSWOK events and activities is important. Please note below how your organization and its programs supported UWSWOK and our efforts. While we don’t expect 100% participation we do expect for partners to participate in a majority of UWSWOK events.
Did your organization participate in the following UWSWOK activities?
David Hegwood Day of Caring held on 4/15/2016: (check all that apply)
|_| Yes, provided a project. |_| Yes, provided volunteers.
|_| Yes, provided food for volunteers completing a project.
|_| Yes, provided funding to assist another agency in completing a project.
|_| No, my organization did not participate in Day of Caring.
Attended UWSWOK Kick Off Event 2017-2018 FY (held on 9/9/2016)? (check all that apply)
|_| Yes, at least one Partner staff member attended.
|_| Yes, at least one Partner board member attended.
|_| Yes, both a Partner staff and a board member attended staff.
|_| No staff member or board member/ advisory council member from my organization attended.
Did your organization provide a Loaned Executive for the 2017-2018 FY? |_| Yes |_| No
If Yes, name of Loaned Executive for 2017-2018 FY: Click here to enter text.
Did your organization complete a fundraising campaign for UWSWOK for the 2016 Campaign?
If Yes, what percentage of your organization staff financially participated in the 2016 UWSWOK Campaign? Click here to enter text.
If Yes, please list amount of funding donated by organization staff towards the 2016 UWSWOK Campaign? Click here to enter text.
If Yes, did you provide pledge cards to your board members/ advisory council members?
|_|Yes |_| No
Did your agency provide staff, volunteer, or board member for a speaking event for the 2016 UWSWOK Campaign and/or 2016//17 FY? |_| Yes |_| No
If yes, please list organization/businesses where you spoke and the dates on which you spoke at the organization/business. Click here to enter text.
If yes, please list individuals that spoke on behalf of your organization to businesses/organizations. Click here to enter text.
Did your organization hold any fundraisers to benefit the 2016 UWSWOK Campaign?
If yes, please name the fundraiser and amount raised: Click here to enter text.
Was your organization a UWSWOK pacesetter for the 2016 Campaign? |_| Yes |_| No
How many monthly UWSWOK Partner Meetings did your organization attend during the last fiscal year? Click here to enter text.
Does your organization promote UWSWOK in your marketing materials, correspondence, signs and other media? |_| Yes |_| No
Did your organization attend any Partner Fairs held at different UWSWOK donors? |_| Yes |_| No
If yes, please name the partner fair(s) your organization participated in: Click here to enter text.
Success Stories (to be completed as part of the Program Effectiveness portion of the Narrative)
Please submit 3 success stories from clients that have benefitted from the program in which your organization is requesting funding. Your agency may choose to have a client write their experience or your organization may summarize a client’s experience using the program for which your organization is requesting funding. Please indicate in each story if it is written by the client or if your organization has written it on their behalf. Clients may remain anonymous when providing this requirement.
Success Story #1:
Click here to enter text.
Success Story is written by: |_| Client |_| Program Staff on Behalf of the client
Success Story #2:
Click here to enter text.
Success Story is written by: |_| Client |_| Program Staff on Behalf of the client
Success Story #3:
Click here to enter text.
Success Story is written by: |_| Client |_| Program Staff on Behalf of the client
Outcomes (to be completed as part of the Program Outcomes portion of the Narrative)
Briefly describe the expected outcomes that directly relate to the 3 Program Goals identified on the Goals form (p. 15). Be as specific as possible about what your organization is working on to accomplish and clearly identify the segment of the population to be served by the program.
Desired outcomes are the results you intent to achieve as a direct result of each identified goal. These may relate to knowledge, skills, attitudes, values, behaviors, condition, or status.
Indicators are specific items of information that will track the program’s success on the stated outcome.
Targets are outcome goals for the program’s upcoming fiscal year
Data source is what will be used to track and measure your data. Examples include, but are not limited to; surveys, written staff observations, data by reliable outside sources, etc.
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Desired Outcome |
Indicator |
Target |
Data Source |
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Example: Students will improve their academic achievement |
Number and percentage of students that will show improvement in state mandated test scores |
Of the 100 third grade students served by the ABC program, 80 students/ 80% will show improvement in state mandated test scores |
1. State mandated test scores 2. Teacher surveys and written observations 3. Student survey |
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Measurement of Progress towards Goals (to be completed as part of the Program Effectiveness portion of the Narrative)
If this program received UWSWOK funding in FY 2016-2017, please Identify the goals that were identified in within that grant application and then answer the following questions with respect to each goal that was identified.
FY 2016-2017 Goal #1: Click here to enter text.
Example: Goal #1: Provide a structured after school program for school age children.
Was the expected outcome for goal #1 achieved? |_| Yes |_| No
Was an impact made on the need identified? |_| Yes |_| No
If yes, how was the impact measured? Click here to enter text.
Did you obtain feedback from the target population being served by the program? |_| Yes |_| No
If yes, what collection method(s) did you utilize for obtaining feedback? Click here to enter text.
Were any adjustments made to the goal to achieve the desired outcome? |_| Yes |_| No
If yes, what adjustments were made for the goal to achieve the desired outcome? Click here to enter text.
FY 2016-2017 Goal #2: Click here to enter text.
Example: Goal #1: Provide a structured after school program for school age children.
Was the expected outcome for goal #1 achieved? |_|Yes |_| No
Was an impact made on the need identified? |_| Yes |_| No
If yes, how was the impact measured? Click here to enter text.
Did you obtain feedback from the target population being served by the program? |_| Yes |_| No
If yes, what collection method(s) did you utilize for obtaining feedback? Click here to enter text.
Were any adjustments made to the goal to achieve the desired outcome? |_|Yes |_|No
If yes, what adjustments were made for the goal to achieve the desired outcome? Click here to enter text.
FY 2016-2017 Goal #3: Click here to enter text.
Example: Goal #1: Provide a structured after school program for school age children.
Was the expected outcome for goal #1 achieved? |_| Yes |_| No
Was an impact made on the need identified? |_| Yes |_| No
If yes, how was the impact measured? Click here to enter text.
Did you obtain feedback from the target population being served by the program? |_| Yes |_| No
If yes, what collection method(s) did you utilize for obtaining feedback? Click here to enter text.
Were any adjustments made to the goal to achieve the desired outcome? |_| Yes |_| No
If yes, what adjustments were made for the goal to achieve the desired outcome? Click here to enter text.
Goals for 2017-2018 (to be completed as part of the Program Effectiveness portion of the Narrative)
Briefly describe 3 goals that have been identified as a priority for the program you are requesting funding for, for FY 2017-2018. Be as specific as possible about what your program is working to accomplish and clearly identify the segment of the population being served.
Describe FY 2017-2018 Program Goal #1: Click here to enter text.
Example: Goal #1 Provide healthy snack with appropriate portion size at an after school program for school age children.
Identify the targeted population who will benefit from this program/goal: Click here to enter text.
Describe FY 2017-2018 Program Goal #2: Click here to enter text.
Identify the targeted population who will benefit from this program/goal: Click here to enter text.
Describe FY 2017-2018 Program Goal #3: Click here to enter text.
Identify the targeted population who will benefit from this program/goal: Click here to enter text.
Program Budget Sheet (to be completed as part of the Program Budget portion of the Narrative)
Financial Summary for Program Name: Click here to enter text.
Proposed budget for FY 2017-2018
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Revenue |
FY 2017-2018 |
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1. Allocation by UWSWOK |
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2. Allocation by all other United Ways |
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3. Contributions |
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4. Special Event and Fundraisers |
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5. Legacies and Bequests |
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6. Foundation Income |
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7. Agency Auxiliaries and Clubs |
Click here to enter text. |
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8. Allocated by Un-associated Fund Raising Organizations |
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9. Fees and Grants from Government Agencies |
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10. Membership Dues |
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11. Program Fees and Net Incidental |
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12. Sales to the Public |
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13. Investment Income |
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14. Miscellaneous Revenue |
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15. Other Click here to enter text. |
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16. Other Click here to enter text. |
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17. Other Click here to enter text. |
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18. Total Revenue (1-17) |
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Expenses |
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19. Salaries and Wages |
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20. Employee Benefits |
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21. Payroll Taxes |
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22. Payroll Subtotal (19-21) |
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23. Professional Fees |
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24. Supplies |
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25. Telephone |
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26. Postage |
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27. Occupancy |
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28. Outside Printing and Artwork |
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29. Transportation |
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30. Conferences, Conventions, and Meetings |
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31. Subscriptions/Professional Publications |
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32. Specific Assistance to Individuals |
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33. Membership Dues |
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34. Awards and Grants |
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35. Rental/Maintenance of Equipment |
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36. Insurance |
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37. Equipment Acquisition |
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38. Miscellaneous Expenses |
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39. Other Click here to enter text. |
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40. Other Click here to enter text. |
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41. Expense Subtotal (23-40) |
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42. Payments to Affiliated Organizations |
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43. Total Expenses (22, 41, and 42) |
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44. Excess (Deficit) (18 minus 43) |
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Supplementary Fund Raising Activities (to be completed as part of the Organization Financials section of the Narrative)
Please list all fundraising activities that were conducted in SW Oklahoma either by your organization or on behalf of your organization during FY 2016. The fundraising activities should be those fundraisers conducted to benefit your program. Do not list fundraisers that your organization did to benefit the UWSWOK.
Fundraiser #1: Click here to enter text.
Date Fundraiser was held: Click here to enter text.
Type of Fundraiser: Click here to enter text.
Gross Income from Fundraiser: Click here to enter text.
Goal Net from Fundraiser: Click here to enter text.
Was the fundraiser sponsored by an outside entity? |_| Yes |_| No
If yes, provide sponsor name and contact person: Click here to enter text.
Fundraiser #2: Click here to enter text.
Date Fundraiser was held: Click here to enter text.
Type of Fundraiser: Click here to enter text.
Gross Income from Fundraiser: Click here to enter text.
Goal Net from Fundraiser: Click here to enter text.
Was the fundraiser sponsored by an outside entity? |_| Yes |_| No
If yes, provide sponsor name and contact person: Click here to enter text.
Fundraiser #3: Click here to enter text.
Date Fundraiser was held: Click here to enter text.
Type of Fundraiser: Click here to enter text.
Gross Income from Fundraiser: Click here to enter text.
Goal Net from Fundraiser: Click here to enter text.
Was the fundraiser sponsored by an outside entity? |_| Yes |_| No
If yes, provide sponsor name and contact person: Click here to enter text.
Fundraiser #4 : Click here to enter text.
Date Fundraiser was held: Click here to enter text.
Type of Fundraiser: Click here to enter text.
Gross Income from Fundraiser: Click here to enter text.
Goal Net from Fundraiser: Click here to enter text.
Was the fundraiser sponsored by an outside entity? |_| Yes |_| No
If yes, provide sponsor name and contact person: Click here to enter text.
Fundraiser #5: Click here to enter text.
Date Fundraiser was held: Click here to enter text.
Type of Fundraiser: Click here to enter text.
Gross Income from Fundraiser: Click here to enter text.
Goal Net from Fundraiser: Click here to enter text.
Was the fundraiser sponsored by an outside entity? |_| Yes |_| No
If yes, provide sponsor name and contact person: Click here to enter text.
Fundraiser #6: Click here to enter text.
Date Fundraiser was held: Click here to enter text.
Type of Fundraiser: Click here to enter text.
Gross Income from Fundraiser: Click here to enter text.
Goal Net from Fundraiser: Click here to enter text.
Was the fundraiser sponsored by an outside entity? |_| Yes |_| No
If yes, provide sponsor name and contact person: Click here to enter text.
Community Impact Calculator (to be completed as part of the Organization Financials section of the Narrative)
It is important for UWSWOK donors to know how each donation impacts the clients of programs that receive funding. This section will be used on the UWSWOK website under “Impact Calculator” and in communication with our donors about the great things our partners’ programs are doing.
Please provide 5 specific examples of how the program uses UWSWOK donations to impact the community. Example: $5.00 provides 3 books for distribution to children in low income and poverty stricken housing.
UWSWOK Donation Impact #1:
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UWSWOK Donation Impact #2:
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UWSWOK Donation Impact #3:
Click here to enter text.
UWSWOK Donation Impact #4:
Click here to enter text.
UWSWOK Donation Impact #5:
Click here to enter text.
Community Impact Equation (to be completed as part of the Organization Financials section of the Narrative)
Please complete the following equations based on the funding requested for the specific program that you are requesting funding for in this grant application.
Example: The ABC transportation program, of the XYZ organization, could provide reliable transportation through bus passes (services) to a total of 100 people with $500 dollars requested from UWSWOK.
1. Click here to enter text. Program, of the Click here to enter text. organization, could provide Click here to enter text. services to a total of Click here to enter text. people with Click here to enter text. dollars requested from UWSWOK.
Example: For $500 dollars the ABC transportation program can provide reliable transportation through bus passes to a total of 100 people.
2. For Click here to enter text. dollars the Click here to enter text. program can provide Click here to enter text. (services) to a total of Click here to enter text. people.
Section 6: Eligibility Requirements Checklist
Please submit the following documentation to complete your grant application. All documents are to be submitted in the order listed when turning the grant application in to UWSWOK staff by deadline date. All documentation should be placed in a binder clip. Please do not commercially bind the document or place it in any type of folder when turning it in to UWSWOK staff.
|_| Completed Partner Cover Sheet
|_| Completed Partnership Agreement
|_| Lucid mission statement of both the Organization as a whole and a mission statement of the Program for which you are requesting funding
|_| Current State Charitable Organization Form
|_| Current list of Board of Directors/ Local Advisory Council members including email, mailing address, and phone number of all members. (Upcoming list of Board of Directors/ Local Advisory Council members if term limits expire within the next 3 months)
|_| Samples of Marketing Materials
|_| Completed Application including Narrative Section and Narrative Required Forms
|_| Partnership Support of UWSWOK
|_| Measurement of Progress Toward Goals
|_| Supplemental Fundraising Activities
|_| Community Impact Calculator
|_| Community Impact Equation
|_| Financial Documents
|_| 990
|_| Current Budget
|_| YTD Budget
|_| AUDIT of entire organization (must have occurred in the last 18 months)
I understand that the grant application is valued at 75% and the program site visit is valued at 25% of the total amount points available for those programs applying for funding.
Disclosure Notice: By submitting this grant application packet and signing below, we certify that the above information is true and correct to the best of our knowledge. We understand that submission of this year’s funding request does not guarantee UWSWOK funding at any level, or in any consecutive year. We also understand that UWSWOK‘s Community Investment Panel assigned to review this funding request may take authority to reassign our request to a specific program focus area or to the discretionary funding area if deemed necessary and appropriate.
Organization Name: Click here to enter text. Program Name: Click here to enter text.
(Print and sign all names below)
CEO/Organization Director: Date:
Board/Council Chair: Date:
Program Director: Date:
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