This field is for validation purposes and should be left unchanged.

Agency Name:(Required)

Tax ID# 501 (c) 3:(Required)

Upload Your 501 (c) 3 letter from the IRS:(Required)

Max. file size: 32 MB.

Agency Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Agency Phone Number:(Required)

Name of Contact Person:(Required)

First Last

Email Address of Contact Person:(Required)

Board of Directors Document:(Required)

Max. file size: 32 MB.

Please upload a PDF or Word Document showing your agency's current Board of Directors.

Audit or IRS 990:(Required)

Max. file size: 32 MB.

Please upload your most recent Audit or IRS 990 here.

Total Agency Budget:(Required)

Program Name:(Required)

Please enter the name of the program for which you are seeking funding.

Total Grant Program Budget UWBC Request:(Required)

(This would be the total amount your agency is requesting of the UWBC for this program. *Reminder: UWBC annual agency grant program funding requests can not include grant writing fees.)

ONE Sentence Summary of Program:(Required)

Please provide a ONE sentence summary of your program (max 200 characters). The sentence must include (if applicable): Brand(s), charitable partners, geography(ies), and number of people and description of people expected to be helped. Please note: We are not asking for an organization summary in this question. For example: Freestore foodbank will use this grant to provide 100,000 meals to disadvantaged children in Towanda through our Backpack Program.

Overall Summary of Program:(Required)

Grant Program Objectives:(Required)

How many individuals will be served with this program? (Numeric answers only)(Required)

Out of the total served, how many individuals will be served under the United Way funding? (Numeric answers only)(Required)

Did this program receive United Way funding last year?(Required)

Yes

Out of the total number served, how many individuals were served under United Way Funding?(Required)

Success Criteria Measurement:(Required)

Funding Principles (Please check one):(Required)

Healthy Community (Improving health & well being for all)

Youth Opportunity (Helping young people realize their full potential)

Financial Security (Creating a stronger financial future for every generation)

Community Resiliency (Addressing urgent needs today for a better tomorrow)

Percentage Served: Asian/American Pacific Islander(Required)