Community Workforce Fund

Organization information

Organization legal name

Organization name as you'd like it to appear in media/print recognition

Ensure capitalization and punctuation are exactly as you'd like them to appear.

Organization website (in URL format)

Include http:// in the webaddress.

Organization phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Name

Title

Phone

Name

Company/Affiliation

Phone

Name

Title

Phone

Organization (or fiscal agent) EIN

After submitting your application, you will need to separately provide your organization's 501(c)(3). Please attach this as a response to the confirmation email you receive.

I understand.

Fiscal agent

Does your organization have a fiscal agent?

Yes

Fiscal agent organization legal name

Fiscal agent president/CEO

Fiscal agent CEO email

Fiscal agent phone

Fiscal agent address

Address 2

City/Town

State/Province

ZIP/Postal Code

Project/program/event information

Name of the program/project/event for which your organization is seeking funding.

Dollar amount requested.

Has this specific program/project/event received funding from United Way of Racine County in the past?

Yes

When?

Is United Way of Racine County the sole funder of this effort?

Yes

If no, describe other funding sources and amounts.

Provide a brief description (3-4 sentences) of the program/project/event. If you only had a minute to explain your program/project/event to someone, what would you want them to know?

Provide a brief description (3-4 sentences) of the specific community need/problem to be addressed by this program/project/event.

How many individual people (unduplicated) will be served by this program/project/event?

Provide demographic information (age, gender, race and ethnicity, income level, geographic location) for those individuals.

What is the start date of this program/project/event?

What is the end date of this program/project/event?

Where will the project/program/event take place?

Describe existing and/or proposed relationships and/or collaborations with other community groups in support of this project/program/event.

What does success look like for this project/program/event?

How will you measure progress towards that success?

Is there anything else you would like the review committee to consider?

All organizations must submit a complete and detailed budget that includes quantities, unit costs and calculations and uses the provided budget template. To provide your budget, respond to the auto-generated email you will receive after submitting your application. Failure to do so within two business days will result in the disqualification of your application.

I understand.

Today's date

I agree to the terms.

All applicants must read, agree to sign, and meet all provisions of the funded agreement and standards including compliance requirements. If organization is currently funded by UWRC, they must be in compliance with all policies and procedures at the time of submitting appropriate requests. An end-of-project report is required of all awarded requests.

I hereby certify on behalf of the organization named in this application that all United Way funds and donations will be used in compliance with all applicable anti-terrorist financing and asset control laws, statues, and executive orders.

Name and Title:

Donate

Community Workforce Fund

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