2018 Sedalia Pettis County United Way Grant Application

Printer Friendly Application (For view purposes only. Web based application will only be accepted.)

2018 Grant Application

Applications must be submitted electronically, with all required supporting documents uploaded by
March 17, 2017 by 5 pm

Note: It is required to login to fill out this form. If you do not have have an account you can register here. You will have the capability to save your applicaiton and come back to it when once you establish a login (username and password). Please write down your username and password. Please call 660-826-2980 with any questions.

Agency Name

Address

City

Zip

Phone

Agency Email Address

Agency Mission Statement

Agency Director's Name

2017 Board President Name

Agency Overhead Rate

Total FTE Staff

Year Round Staff

Seasonal Staff

Agency Fiscal Year

Description of the organization's primary purpose:

Highlights of the organization's accomplishments in the past three years:

Does your agency have a national affiliation?

Number of members of the agency's board of directors stipulated by the agency by-laws:

Actual current number of members:

Number of board meetings per year according to by-laws:

Number actually held:

Average attendance at the agency's board meetings over the previous 12-month period:

Are you asking for increased dollars of support?

If yes, why are you requesting more money?

Are you requesting United Way dollars to meet a matching funds requirement?

If yes, please list the funders for which you are requesting matching funds.

If your agency was not funded for the full amount you requested in 2016-17, what impact did this have on your agency? What adaptations did you have to make?

How will the agency adapt if your requested funding level cannot be met?

Do you have a strategic plan?

If no, how has your agency addressed the areas of education, income, safety net services and health?

Sliding Fee Schedule:

Insurance Reimbursement:

Government Subsidies:

Other Fees:

Target Population and Eligibility Requirements Data

Similar Program Data

Relationship Data

Volunteers Data

no use of volunteer explanation

Change In Programming Data

Organizational Structure Data

Area of Impact

Average Expense Per Client Served in Previous Year:

Have you received SPCUW funding before?

UW Logo

Campaign Involvement

Packet Distribution

Internal Campaign Efforts

Agency Agreement Reviewed

990 Signed (Most Recent)

Agency Audit or Review (Most Recent)

Board of Directors List

Board of Directors Attendance Records

Certificate of Good Standing with the MO Secretary of State's Office

Application Narrative

2016 Data For Impact Analysis Narrative

IRS Determination Letter

Management Letter from Auditor (Most Recent)

Program Budget/Explanation of Budget Variance

UW logo samples

Grant Application Data and Signatures