Grant Application

United Way Fox Cities Youth Board

Must be completed by the Youth Plannersand it must betyped.

For assistance please contact Michele Losey, Youth Board Advisor, United Way Fox Cities.

1455 Midway Road Menasha, WI 54952

Project Title:

Project Start Date:Project End Date:

Sponsoring Organization:

Organization Address: City:Zip:

Youth Contact Person:

Youth Email: Youth Phone:

Adult Contact Person:

Adult Email: Adult Phone:

Total Project Expense:Amount Requested:

READ THE ENTIRE APPLICATION BEFORE ANSWERING ANY QUESTIONS.

  • Please note that grant applications are accepted at any time during the school year. Grant Deadlines: applications must be submitted by the 1st Monday of November for the fall cycle and the 1st Monday of April for the spring cycle; with funding becoming available six to eight weeks after the end of each funding cycle.
  • If your application is deemed complete and timely, your organization will be asked to send a representative to present your grant proposal at a Youth Board meeting. This will be your opportunity to present additional supportive information on behalf of your organization’s request. Please be prepared to explain your project’s goals and budget. Youth Board members will ask questions at the conclusion of the grant presentation. Fall grant presentations will take place on the 3rd Monday in November; and Spring grant presentations will take place on the 3rd Monday in April. More information about a specific time will be emailed once to your group once the grant cycle has closed.
  • If you need assistance in completing this application please contact a United Way Youth Board Representative or the following United Way staff:

Michele Losey, Youth Board Advisor
United Way Fox Cities

1455 Midway Road

Menasha, WI 54952
920-735-5460

  • Complete all sections of the application and keep a copy of the application for your group. Please email and/or mail the completed grant application, with signatures, using the above contact information by each semester deadline.

1. Please provide a description of your project. (150 Words, Maximum)

2. What Developmental Assets will the project address? (go to or unitedwayfoxcities.org for a list of Developmental Assets)

3. Who will plan and carryout the project? Who will benefit? How many of each?

How Many Youth Planners/Organizers
How Many Youth Participants/Recipients
How Many Adult Planners/Organizers
How Many Adult Participants/Recipients
Other people that might be affected *

* If included above, explain what “other people” means to your project.

4. Use the table below to outline your work/action plan. Note that some Youth Board (YB) items are required. Status is Pending, In Progress, Not Applicable or Complete. (P, IP, NA, C)

TASK / Start Date / End Date / Person / Status
Public announcement of YB funding
Written outcome report to YB

5. How will youth be given recognition for work on this project?

6. How will you know if your project is successful? What is your evaluation plan?

7. Has your organization applied for other grant opportunities for this project? If yes, please provide a brief list. If no, please explain why you have not applied for other grants.

8. What exactly are you asking the United Way Fox Cities Youth Board to pay for? (Check your budget form.)

United Way Fox Cities

Youth Board Grant Application

Project Budget

REVENUE

/ DESCRIPTION /

PROPOSED

($) /

APPROVED

($)

  1. Contributions

  1. Membership Dues

  1. Activity Fees

  1. Product Sales

  1. In-Kind Contributions

  1. Other

UNITED WAY FOX CITIES / YOUTH BOARD Grant Request
TOTAL REVENUE *

EXPENSES

/
DESCRIPTION
/ PROPOSED ($) /

TOTAL

($)
  1. Staff/Benefits

  1. Supplies

  1. Equipment

  1. Printing

  1. Postage

  1. Travel

  1. Other

TOTAL EXPENSES *

* Total Revenue and Total Expenses should be equal amounts.

Maximum dollar amount typically available per school/organization is $500. The Youth Board Grant Program has a total of $2,000 per semester that may be granted. The Youth Board uses a voting procedure during scheduled meetings to make recommendations for grants. Final approval comes from the United Way Fox Cities Board of Directors.

Assurances

Youth and adult signatures are required on this application.

I do hereby attest that youth are totally involved with the planning and delivery of this proposed program. Furthermore, I believe that all United Way funds granted through this application will be used in the ways described herein.

Name: ______Signature: ______Date: ______

(Youth)

I do hereby attest that youth are totally involved with the planning and delivery of this proposed program. Furthermore, I will assure that all United Way funds granted through this application will be used in the ways described herein.

Name: ______Signature: ______Date: ______

(Adult)

1