Only current United Way funded agencies are eligible to apply for this funding. 1 Start 2 Complete Agency Information Agency Name * Full Physical Address * Full Mailing Address * Agency Phone Number * Agency's Fax Number Is your agency a non-profit? * Yes No Agency Email Address * Agency's Website Address * Is your agency a Unit of Government? * Yes No Is the Agency Debarred From Receiving Funds or Doing Business with the Federal Government? * Yes No Is the Agency Suspended From Receiving Funds or Doing Business with the Federal Government? * Yes No DUNS Number * EIN Number * Unique Identifying Number * Funding Request What type of funding are you requesting? * Food Shelter Utilities Rent/Mortgage How much are you requesting for the Food Program? * $ How much are you requesting for the Shelter Program? * $ How much are you requesting for the Utilities Program? * $ How much are you requesting for the Rent/Mortgage Program? * $ Describe the Program * Target Population * How long has this program existed? 2020 Total Operating Budget? * 2021 Total Operating Budget? * 2022 Total Operating Budget? * Anything you need us to know File Uploads Upload your most recent 990 * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Upload your most recent Audit or Financial Statement * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx. Upload your Current Board List * Board Roster MUST include: Name, Title, Phone Number, Email Address of each MemberFiles must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.
