For organizations applying for funding for multiple programs, use the format below to complete the applications for the second, third or fourth programs. Please save a separate document for each program. This application is ONLY to be used for those applying for multiple programs. Your primary application must be completed online before this document will be accepted. Organization Overview Organization Name
Program Overview The following section refers to the program for which you are requesting funding.
Program name
Funding request amount $
Submit a 25-30 word description of your program for use in United Way publications
Brief statement of the need or problem to be addressed by the program
Provide a general statement of what the program is designed to accomplish. Objectives should be linked to the above identified community need and/or target population served
United Way Focus Area - Choose Only One:
o Education o Income
1 o Health
Geographic area served – Which of the following counties does your organization serve? o Calhoun o Jackson o Pleasants o Ritchie o Roane o Wirt o Wood Ohio o Athens o Washington Client Data Indicate the total number of unique clients/participants served in your most recently completed fiscal year
Indicate the total number of clients/participants served in your most recently completed fiscal year
Indicate the projected number of clients/participants for the current fiscal year
Indicate the projected number of clients/participants for the next fiscal year
Are fees charged to program participants? If yes, what is the fee scale, how is it assessed and what is the procedure if a person cannot afford to pay?
List other organizations that refer clients/participants to this program
Program Inputs What resources does the program use to achieve its objectives?
Specifically, how will United Way funding be used to support this program?
Do you rely on volunteers, students, or interns to run the program?
If yes, what is your contingency plan if you are unable to secure that support?
2 Please describe what the program does with its inputs; i.e. , what services the program provides to fulfill its mission
Program Outputs Outputs are measurable products of a program’s activities. Outputs are to be represented as “units of service.” Examples of units of service are meals provided, nights of shelter, classes taught, etc.
Define a unit of service for this program
Indicate the number of units of services provided in each of the following time periods:
Most recently completed fiscal year
The preceding fiscal year
Define a second unit of service for this program
Indicate the number of units of services provided in each of the following time periods:
Most recently completed fiscal year (second unit of service)
The preceding fiscal year (second unit of service)
Program Outcomes What are the benefits to participants during or after their involvement with the program? Outcomes may relate to knowledge, skills, attitudes, values, status, behavior, or condition. Examples include improved reading skills, obtaining employment, decreased instances of substance abuse, etc. List desired outcome #1 of your program and at least one indicator that will support the outcome.
List desired outcome #2 of your program and at least one indicator that will support the outcome.
Please detail a brief success story from this program
3 List committed and requested financial support from other sources for this program
What other organizations are doing similar work to this program and how is yours different?
What are the organization’s most significant interactions with other organizations and efforts, with respect to this program?
To help donors better understand the impact their giving has on community need, please provide three examples of how gifts can provide services to clients
Does your program specifically address any of the following community needs?
o Drug epidemic in the Mid-Ohio Valley o Obesity o Early Education
File Uploads Email the following attachments, along with your saved application, to [email protected] Current fiscal year program budget Most recently completed fiscal year program budget One document of your choice to support your application (optional)
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