Community Impact: Indicate which United Way priorit(ies) are impacted by the program/project for which funds are requested. If more than one, rank in order of impact (1 = greatest impact, etc.).
I am authorized to submit this Request for Funding on behalf of the above-named agency.
Signature
Name and Title (please print/type)
1. Name of Project: ___________________________________
2. Amount Requested: $_____________
3. Project Summary: Please provide a detailed summary of the project for which funding
is requested, including information such as target audience, plan to reach and engage the target audience, anticipated number of participants, nature of contact(s) with participants, names and examples of curriculum materials, etc. Use additional page(s) as needed.
4. Outcomes: Please provide a detailed list of intended outcomes, as related to the Community Impact Priorities indicated on the cover sheet, and plans for assessing the success rate in achieving each outcome. Use additional pages as needed. Attach any relevant documentation.
5. If the project was operational during either or both of the preceding two years, please indicate the number of unique individuals served in each county.
COUNTY |
2012 |
2013 |
Ben Hill County |
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Cook County |
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Irwin County |
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Tift County |
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Turner County |
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6. Budget: Attach a detailed budget for the project. Explain the proposed use of United Way funds within the budget. List all other income (sources and amounts) either received or requested for this project.
7. Sustainability: If the project is designed to continue after the period for which funding is requested, please explain how it will remain sustainable after requested United Way funds are spent.
8. Please provide any additional information that you wish to be reviewed by the Allocations Committee and/or United Way Board of Directors.