2010 Request for Funding Proposal – RiverValley United Way

Deadline for submission: 5:00pm, August 28, 2009

AGENCY NAME:

PROGRAM NAME:

COMPLETED BY:

TITLE:

ADDRESS:

CITY, STATE, ZIP:

E-MAIL ADDRESS:

TELEPHONE:

Does your organization have 501(c)3 status?

Federal ID #

Funding amount requested for calendar year 2010:

Estimated number of persons to be served:

Counties to be served by this program:

Please indicate ONE Community Impact Area in which your program addresses a health and human services need (Education, Income or Health):

This proposal was considered and approved on the______day of______, 2009 by the Board of Directors of ______.

Signed: ______Title:______

Signed: ______Title: ______

Please initial to indicate that you have read each of the following statements:

It should not be presumed that any applicant will be awarded a grant on an annual basis, nor should the availability of these grants be considered an annual part of an applicant's budget. Initial here:

No grants will be provided for sectarian religious purposes, non-human services, athletic teams, events, school activities to which school credit is earned, political activities, building and land improvements, or to fund prior year deficits. Initial here:

RIVERVALLEY UNITED WAY 2010 FUNDING APPLICATION FORM

Agency Name:

Program Name:

Agency Fiscal Cycle:

Amount Requested:

PROGRAM BUDGET

REVENUE

FISCAL 2010 BUDGET / ACTUAL FISCAL 2009* / ACTUAL FISCAL 2008
RiverValley United Way / N/A
Other United Ways
Government Support
Foundations/Private Grants**
In-Kind Support
Client/Program Service Fees
Contributions***
Other Revenue**
TOTAL PROGRAM REVENUE
Foundations/Private Grants:
Contributors:
Other Revenue:

*If fiscal year is not closed upon application, please project figures to end of fiscal year and indicate below that you have done so.

**Provide sources below

***Individual contributions may be categorized as one line item unless a single contributor is responsible for over 5% of total funding for the agency.

  • ARE FISCAL 2009 FIGURES ARE PROJECTIONS BASED UPON ACTUAL EXPENDITURES?
  • FROM YOUR LATEST IRS FORM 990, WHAT PERCENTAGE OF YOUR ORGANIZATION'S EXPENSES ARE ADMINISTRATIVE/FUNDRAISING COSTS?
  • Does the agency anticipate any significant changes in its resources, program services or clients served for the upcoming year? Please provide explanation of any unusual increases or decreases in the program's revenues and expenses, including any external issues or trends that may affect the program.

EXPENSES

FISCAL 2010 BUDGET / ACTUAL FISCAL 2009* / ACTUAL FISCAL 2008
Salaries
Benefits/Taxes
Professional Fees
Supplies
Assistance to Individuals
Travel
Telephone
Occupancy
Payment to Affiliates
Major Property/Equipment Acquisition
Conference/Training
Other: Please submit detail below
TOTAL PROGRAM EXPENSES
Other Expenses Detail:

VOLUME & UNIT COST

Total # of program units:
Cost per unit:
(Total program expenses/total # of program units)
Last year's unit cost:
A unit of service for this program is defined as:

BALANCE SHEET

2009 / 2008 / Increase/Decrease
CURRENT ASSETS
CASH
SHORT TERM INVESTMENTS
ACCOUNTS RCVBL
INVENTORIES
PREPAYMENTS
INTEREST RCVBL
OTHER CURRENT ASSETS
TOTAL CURRENT ASSETS
RESTRICTED FUNDS
CASH
OTHER
TOTAL RESTRICTED FUNDS
LAND, BUILDINGS & EQUIPMENT
LESS: ACCUMULATED DEPRECIATION
NETLAND, BUILDINGS & ASSETS
OTHER ASSETS
TOTAL ASSETS

LIABILITIES AND FUND BALANCES

2008 / 2009 / Increase/Decrease
ACCOUNTS PAYABLE
NOTES PAYABLE
CURRENT MATURATES – LONG TERM DEBT
DEFERRED INCOME
RESTRICTED FUND
OTHER CURRENT LIABILITIES
TOTAL CURRENT LIABILITIES
FUND BALANCES
TOTAL LIABILITIES AND FUND BALANCES

PROPOSAL NARRATIVE

A. ORGANIZATION CAPABILITY

  1. Please provide the mission statement and vision of your organization.
  1. Please provide an overview of your organization including areas of expertise, accomplishments and population served.
  1. Please list other community entities that collaborate with your organization.

B. AGENCY NEED STATEMENT

  1. Describe population to be served including geographic location.
  1. State the circumstances, issues and/or barriers, faced by the agency's targeted population that warrants the need for the agency's services. Please use data and statistical evidence (i.e. local data, waiting list, community surveys) to support your response.
  1. Identify similar programs that are currently serving the needs for your targeted population and explain how your program differs from currently offered services.

C. PROGRAM DESCRIPTION

1.Please state the program name.

  1. Please list program funding needs (including dollar amount), in order of priority.
  1. Explain how program activities and services will be provided including location of services.
  1. Please detail how proposed program and services to be provided (methodology) will reduce barrier described in PROGRAM NEED STATEMENT (B2). Please include reference to any studies or evidence that indicates proposed strategies are effective with target populations.

PROGRAM OUTCOMES

Community-wide impact: Please provide information about the cumulative "return on investment" realized for the community during the program year.

D. CLIENT OUTCOMES

Describe changes or benefits clients will receive as a result of this program. Please include your major desired outcomes for this program.

Outcomes
(specific statement of the desired change in the lives of a particular group) / Outcome Measurement (information that indicates how well the program id doing regarding an outcome) / Goals
(Broad statement of desired condition of well being for particular group)

E. DEMOGRAPHIC INFORMATION

2009 Clients Served (Effective 2009 funding cycle, this information is required.)

Program Name:
Total # of unduplicated clients:
Gender
Male: / Female:
Race
White: / Black: / Latino: / Other:
Age
0-12: / 13-20: / 21-40: / 41-64: / 65+

DIVERSITY EFFORTS

Please describe efforts this program has made, or is making, to reach out to or increase access for the varied and diverse groups of people that reside in the RiverValley. What has this program done to address needs of specific groups?

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