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1. General Agency Information

2. Public or Private Grants

3. Capital Fundraiser

Capital Fundraisers are one-time campaigns set within a definite time frame for a special or specific major project (building, endowment, and/or major equipment usually over $25,000).

4. Statement of Financial Position

Upload documents for each item below using figures from most recent FY audit or your financial software program. If you don't have one of the required documents, you may skip the step, but the form requires that you upload a document so you may upload a blank Word document.

INFORMATION ABOUT PROGRAM

Please prepare one Program Information Section for each United Way of Whiteside County funded program.

1. Funding Requests For This Program

2. Program Background

3. Coordination and Collaboration

4. Program Sustainability

5. Individuals Served

Provide number of unduplicated persons served by this program in each geographic area in the fiscal year. (Auxiliary or supportive services, such as survey, brochure, and newsletter are not to be counted as persons served.) Numbers listed below should be UNDUPLICATED numbers.

Age

Actual statistics for your funding (calendar) year 2020

Gender

To which gender identity did your client most identify? Actual statistics for your funding (calendar) year 2020.

Ethnicity

Actual statistics for your funding (calendar) year 2020.

Income Level

If available as defined by your agency. Actual statistics for your funding (calendar) year 2020.

Numbers of people served by location

Actual statistics for your funding (calendar) year 2020.

6. Outcome Measurements- Must use template

Use the form provided within the instructions for this application.

7. United Way Community Pillars

Please indicate where your United Way allocation dollars will be spent. The dollar amount in all the categories should equal the amount of total dollars requested. The undefined category is for those programs that do not serve persons in the other categories.

8. Program Financials

Please indicate where your United Way allocation dollars will be spent. The dollar amount in all the categories should equal the amount of total dollars requested. The undefined category is for those programs that do not serve persons in the other categories.

9. Promotion

10. Signature

In the event any of the information contained in this allocation request is deemed false or misleading, United Way of Whiteside County reserves the right to place restrictions on the Agency’s use of United Way money or to reduce or terminate funding.