Form C– General Initiative Proposal

Please submit one (1) per General Initiative proposed for funding.

Agencies may only submit three (3) RFP’s per Focus Area.
*Please submit 5 copies of Forms C & D.

Applicant Organization ______

Initiative Name ______

Annual Funding RequestPercentage of Total Revenue for Initiative

$______(7/1/16 – 6/30/17)_____% (Request/Total Revenue for Initiative)

Was this Initiative Funded Last Year? No __ Yes __ $ Amount ______

Type of Strategy: Check one that best describes the type of strategy proposed.

__ Systemic Change: Strategic efforts through creative and diverse partnerships that offer the opportunity to enact change that moves beyond thinking about individuals and individual organizations. One example of a systemic changewould be the development of a new transportation system in the community.

__Direct Service Initiative(s): Efforts that improve lives by delivering assistance directly to specific individuals and families. A set of related activities that leads to desired outcomes of individual(s), families, groups, etc.

Focus Area:Check one that best describes the organization’s Initiative.

With a mission to “unite people, ideas and resources to improve the lives of people in Greater Plymouth County”,United Way of Greater Plymouth County aims to direct resources to the most vulnerable, lowest incomepopulation in our community. Therefore, we support programs that promote the education of our youth, the physical health and healthy lifestyles of our most vulnerable neighbors, and the financial stability of our families.

__ Education:Helping our children through early learning opportunities to be ready for school, helping our youth to be successful in school and safe through after school initiatives, vocational opportunities, and mentoring in order to ensure their graduation from high school and success in higher education and gainful employment.

__ Income: Providing for the basic needs of food, shelter and clothing for our families and our most vulnerable neighbors as well as affording pathways for them to financial literacy, sustainable employment and decent, affordable housing.

__ Health: Promoting the physical health, wellness and healthy living of our neighbors through access to health care, dental and prevention services. Treatment interventions are aimed at providing services to our elders as well as to reducing child abuse, mental illness, substance addictions and domestic violence.

Form C– General Initiative Proposal (continued)

Initiative Description

Please describe the design of the initiative project, using the following criteria.

PLEASE RESPOND TO NUMBERS 2 THROUGH 5 WITH BULLETTED RESPONSES.

Partnerships & Collaborations Documentation

Applicants are encouraged to develop collaborative proposals that build synergy between multiple agency and community partners. Such collaborations will be recognized and rewarded in the investment process. Please provide names of all committed Collaborating Organizations below.

Collaboration is shared decision-making, shared resources and shared accountability among participating organizations and groups. It does not include organizations or groups which the agency has cooperative working relationships or referral relationships only. It is the ongoing, collaborative effort that directly relates to the project’s outcomes. Examples of collaborations include financial, operational, structural, facility sharing, etc.

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Signature of Lead Organization Executive Date

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Printed Name, Title and Organization

Partners/Collaborators and Contacts

______

Name of Other Collaborating Organization Contact Name

______

Name of Other Collaborating Organization Contact Name

______

Name of Other Collaborating Organization Contact Name

______

Name of Other Collaborating Organization Contact Name

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Name of Other Collaborating Organization Contact Name

6. Site Visit (20 Points)A site visit provides the opportunity for volunteer allocation panelists to witness the consistency of what is contained in the narrative of the proposal for the initiatives and the actual services, staffing and facilities involved in the proposal. Among other criteria, the following will be taken into consideration during the site visit:
Facility
Staffing
Evidence of Collaboration
Evidence Population Served (Diversity)
Visual evidence of United Way Partnership

7. Proposed Initiative Budget (10 Points)

Please complete supplied Form D budget template.

Forms C & D must be received on or before 4:00 p.m. Friday, FEBRUARY 19, 2016

Rev. 11/20/2015Page 1 of 8 FORM C