SECTION 1: Agency Information

Agency Name

Agency Website

http://

Agency Facebook

http://

Agency Instagram

http://

Primary Contact Title

Primary Contact Email

Grant Writer Title

Grant Writer Email

Number of Employees

Agency Mission

SECTION 2: Agency Fundraiser Information

Name of Annual Fundraiser:

Date of Annual Fundraiser

Amount fundraiser is expected to raise:

Do you seek Corporate Sponsors for your event?

Descriptions & purpose of Annual Fundraiser

SECTION 3: Program Information

Program Name

Amount Requested

Impact Category (choose one - if more than one fill out a new form for each)

1. Program Background:

2. Who is your target population for this program?

3. Provide the total number of unduplicated individuals served for this program:

8. Explain specifically how United Way funding will be used (include whether the funding will help add new services or supplement funding to maintain current service levels). Measurable Outputs How do you measure the success of your program? Below are examples of measurable outputs, or you can create your own. You are not limited to the number you can provide, but you must provide at least two outputs and one outcome statement (explanation). This information will be required for quarterly reports which will be reviewed by the Community Investment Committee.

Examples: Provided emergency shelter for women and children, percentage of shelter residents obtained employment or other source of income, percentage of unhoused individuals who identified their medical and mental health needs, number of families assisted with emergency utility assistance, referrals made for permanent housing opportunities, number of children or working parents who were provided low cost/no cost after hours care, etc.

9. Please provide at least one measurable output and explanation (see examples above).

10. Describe the methods you will use to track outcomes in this program. If there are metrics you are not currently tracking, please explain your plan to obtain the necessary data to do so.

11. List any influencing factors affecting the outcome results from the outputs provided.

12. What else would you like us to know about your program?

13. Estimated number of individuals not served due to limited resources:

14. Could your program also align with any other United Way Impact Area? If so, which one?

15. Current total annual program budget:

16. List any other current funding sources for this program:

SECTION 4: Required Documents

SECTION 5: Obligations of Agencies

Please Answer Agree or Disagree to each question.

SECTION 6: Additional Comments

Add any additional comments here:

SECTION 7: Signature Submission

Typing your name below is an agreement that the information submitted on this application are true and accurate, to the best of my knowledge..

2025 Grant Application

United Way of Danville Area