Grant Application

ABOUT UNITED WAY OF MITCHELL COUNTY, INC

The United Way Mitchell County, Inc. (UWMC) provides qualified agencies grants to fund projects or programs or events that contribute to the health & welfare of Mitchell County residents.

INSTRUCTIONS

The UWMC Grant Application consists of five (5) parts as explained below.

Part 1 – The Application Form

You will need Microsoft Word version 2007 at a minimum.

Tab through the document in order to complete all fields. If you cannot answer a field or that field is not applicable, please enter“N/A”. Do not leave a field blank.

Part 2 – The Budget

Your Budget will be used in determining the amount of funding received, as applicable. Funds, if received, will not be allowed to be used for any purpose other than this project. Any unspent portion of funds at the end of the Project must be returned to UWMC. Once the project is funded, if a line item is deleted, the funds may be reallocated to other portions of the Project provided that the reallocated funds are not used for a prohibited expense.

Please make sure that each “Expense Item” name is a clear description of the expense.

Round all funds to the nearest dollar.

Part 3 – The Attachments

The UWMC requires certain documents to accompany this Grant Application in order for our Board to have the best information to assist in our funding process. Incorporated in this Package is a Checklist to help you make sure that all required forms are submitted.

We only require one (1) copy of these documents.

Part 4 – Our Documents to You

We have attached UWMC documents that you need for your information or to facilitate parts of this Grant Application package.

Part 5 – Agreement and Signatures

By signing Part 5, you agree to the terms of the UWMC Grant as set forth in this application package and attest that the information provided is true and accurate to the best of your knowledge and ability.

After completing this Application, print all five (5) parts, sign as specified and date it. If your Board requires any signatures besides the preparer’s signature, please have the appropriate member also sign the form.

Your President and Secretary must attest as noted.

Submission Package

After completing and signing the Application, make ten (10) copies of the Grant Application Parts 1 - 5 and assemble your Grant Application package in the order specified in Part 3.

Make sure that you keep a copy of the Grant Application package for your use.

DEADLINE DETAILS

The complete Application Package is due in the United Way of Mitchell County, Inc. office by 5pm on December 31st. If this falls on a weekend, the package is due on the first business day immediately following. Grant Application Packages received after this time will not be considered for funding.

Screening Committee

The United Way of Mitchell County, Inc.

31 Cross Street Building, Suite 210

Spruce Pine, North Carolina 28777

THE REVIEW PROCESS

Applications are screened for completeness, clarity and compliance with eligibility requirements. Grant proposals are evaluated and, if selected, a personal interview with the Allocations Committee is required in February. Final funding decisions are approved by the United Way of Mitchell County, Inc.Board of Directors and announced via email in March. If you do not receive this notification email by April 1, please contact the Executive Director.

ASSISTANCE WITH THIS APPLICATION

If you have any questions or need assistance with this Application Package, please contact the Executive Director via email () or telephone (828) 765-7724.

PART 1: APPLICATION

Complete All Fields

Funding Cycle: 20

Agency Information
Agency Name: / 501(c)(3) 501(c)(4)
Street Address: / City: / State: / Zip:
County:
MitchellYanceyAvery / Phone Number:
()- / Contact Person:
Email Address:
Federal Tax Exempt Number or Federal Employer ID:
NC Charitable Solicitation License Number or reason you are exempt:
Project Information
Name of Project:
Describe your Project and its history:
Project Start Date: //20
Project End Date: //20 / Who does this Project benefit? / How many people will this Project serve?
Why is this Project important to the community? / Are you partnered with another Non-Profit Agency on this project? Yes No
Please list them:
Total Budget for this Project: $ / Amount you are requesting for this Project: $
If UWMC cannot fund the entire requested amount, will you be able to complete this Project? Yes No
Describe your plans for evaluating your Project. What will completion of a successful Project look like to you?
Advertising & Fund Raising Information
Provide a summary of your publicity plan, including media contacts, brochures, mailing dates, radio, and internet advertising:
Describe other fundraising efforts you will make for this Project:
List confirmed sources of income which are available for your Project:
Former Project Information
Has your Agency ever received a Grant from UWMC? Yes No / If yes, please indicate the Project Name and date:
What has been learned and what changes have been made from the previous Projects in relation to this proposal?

Funding Cycle: 20

Project Name:

Completed By:

PART 2: BUDGET

Expense Items / UWMC Funds / Other Sources / Total / UWMC
Use Only
Total amounts must be equal to those listed on the Application Form under the applicable fields

Funding Cycle: 20

Project Name:

Completed By:

PART 3: ATTACHMENTS

Attached / Document / UWMC
Use Only
Original signed & dated Application Parts 1 - 5
Copy of State Tax Exempt Letter
Copy of latest 990 Form
Current Board Contact List, including phone numbers
Copy of your current Anti-Discrimination/Harassment Policy
Brochures or other information on your Agency
Brochure or other information on previous Projects or this Project (optional)
Ten (10) copies of Grant Application Package

All documents must be submitted in the order above.

PART 4: UWMC DOCUMENTS

Document / Your Action(s)
UWMC By-Laws / Your Board must approve to abide by our By-Laws; your Board President and Secretary must sign Part 5 to attest that this is true
UWMC Anti-Discrimination/Harassment Policy / Your Board must approve to abide by our Anti-Discrimination/Harassment Policy; your Board President and Secretary must sign Part 5 to attest that this is true
Check List for Publicity Requirements for Funded Programs / For your use and information
Mid-project and Final Report / For your information

Funding Cycle: 20

Project Name:

Completed By:

PART 5: AGREEMENT AND SIGNATURES

By signing and submitting this Application, the Agency agrees to the following and understands that failure to comply with UWMC requirements may result in the defunding of the Agency:

  1. The Agency will adhere to the Publicity Requirements for funded projects/programs (a Checklist is included in this package for your use);
  2. Any received funds will be used for no other purpose than that listed in Part 2 of this application;
  3. Any unspent portion of funds at the end of the Project must be returned to UWMC;
  4. Once the Project is funded, if a line item is deleted or reduced, the Project Funds may be reallocated to other portions of the Project, provided that the reallocated funds are not used for a prohibited expense.

This Application is true and accurate to the best of my (our) knowledge & ability and we commit our Agency to adhere to the foregoing guidelines and requirements of UWMC:
Project Director:
______
Signature
Name: Date: //20 / Grant Writer (if not Project Director):
______
Signature
Name: Date: //20
Our Board has reviewed UWMC’s By-Laws and its Anti-Discrimination/Harassment policy and approved to abide by them. Attested:
Board President:
______
Signature
Name: Date: //20 / Board Secretary:
______
Signature
Name: Date: //20
Other Signatures as required by your Board
______
Signature
Name: Date: //20
Title: / ______
Signature
Name: Date: //20
Title:

Version: 2013