Community Impact Grant Application – United Way of Whiteside County

Agency Name*
Address*
Email Address Of Main Contact*
Phone Number Of Main Contact*
Program Name Applying For Grant*
Amount of Funding Requested*
Program Description*
Is this a new program?*
- Yes
- No
Program Budget
Please insert the program budget for the most recent fiscal year ended, if applicable.
6MB size limit
Allowed file types: jpg,jpeg,png,pdf,doc,xls
Accepted file types: jpg, jpeg, png, pdf, doc, xls.
Please Explain How You Will Use UW Funds.*
How Many Whiteside County Residents Are Served By This Program?*
How do you know if your program is successful? What are the benefits or changes for individuals during or after participating in program activities. How well is the program achieving the desired outcome?**
How has Covid -19 affected your organization? How do you think it will affect your organization in 2021?*
Name Of Person Preparing Form*
First Last
Date*
Date Format: MM slash DD slash YYYY
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