United Way of Enid and Northwest Oklahoma

UNITED WAY OF ENID AND NORTHWEST OKLAHOMA

VENTURE GRANT APPLICATION 2018

The Venture Grant Program is separate and distinct from the regular United Way allocation system. Applicants do not need to be member agencies of the United Way to apply. Venture Grants will be evaluated in conjunction with the Budget/Allocation process. Venture Grants should be responsive to the needs of the community they target.

Only programs with measurable outcomes that meet identified community needs will receive funding. You are strongly encouraged to present as much information as possible in the Needs Section to identify unmet or unidentified needs.

United Way of Enid & Northwest Oklahoma Community Impact Areas:

Programs not meeting these needs will be considered for funding, but should present strong, detailed, comprehensive information in the Needs section to justify funding.

Agency Eligibility

If your agency/organization meets the following criteria, it is eligible to apply for a Venture Grant. (Note: United Way partner agencies do not have to submit any current support documentation if it is already on file with United Way).

1.Must be certified by the IRS as a 501(C)(3) agency.

Agency/organization’s primary area of service must be in this United Way’s service area.
Must be governed by an active volunteer Board of Directors.

4. Agency/organization is proposing a service that has significant promise for improving the health and/ or welfare of the citizens of this area or is extending vital services to a new, clearly defined population group or geographic area within this United Way’s service area.

5. Must be able to utilize the funds as authorized and by the established deadline of the grant.

Must provide an audit if the agency annual budget is over $100,000, and Form 990 if annual receipts exceed $25,000.

Funding Notification and Disbursement

Grantees will be notified of funding decisions and funds will be distributed after July 1st, 2018.

Grant Review Structure and Composition

The Venture Grant Committee will be composed of the Budget/ Allocation Committee with final action to be approved by the United Way Board of Directors. The Executive Committee may also periodically review Venture Grant applications as needed.

Funding Criteria

The Venture Grant Committee will evaluate applications according to the following criteria.

1.How it meets Community Impact Areas as noted on page one.

2.Evidence of specific need for the proposed program and how this was determined.

3.Specific measurability of program success (how will the success to the clients/community be measured).

4.The number of participants or systems that will actually be impacted.

5.Grant cost versus expected impact to the community.

6.Evidence of non-duplication of services if similar programs are in the service area.

7.The agency’s ability to implement programs and attract future funding. If program receives a grant, how will your agency be able to continue the program?

Final Report

For successful grantees, a final report is due within 30 days after project completion. This report should include a final detailed financial report, a narrative of any program highlights, and the program’s success based on the measurability criteria (Program pages in the application). It should also explain how the program will be continued and with what funding sources.

Grantees failing to submit a final report will be ineligible for future Venture grant funding.

APPLICATION PROCESS

Submit the original application and 7 copies to the United Way by 3:00 p.m., April 30, 2018. A digital copy must be e-mailed to: by the deadline.

Questions about the Venture Grant Program should be directed to:

Dan Schiedel, Executive Director

United Way of Enid and Northwest Oklahoma

P.O. Box 5828

Enid, OK 73702

(580) 237-0821

Email –

2018Venture Grant Request

UNITED WAY OF ENID & NORTHWEST OKLAHOMA

Date Submitted: ______

Agency Name:______

Agency Address: ______

Mailing Address (if different): ______

Contact Person for this Proposal: ______Contact Number: ______

Contact Email Address: ______

Has your agency received a Venture Grant in the past 10 years? ☐Yes☐ No

If YES list each year and amount for the past 10 years:Click here to enter text.

Total Requested Amount:

Attach (only to the Original Application) each of the following: (These are not required for United Way member agencies, if they’re already on file):

A.A copy of your IRS 501(c )( 3 ) exemption letter.

B.A copy of your last fiscal year IRS Form 990.

C.A copy of your CPA audit for your last fiscal year.
D.A complete list of your current Board of Directors.

______

Chief Volunteer Officer's Name Chief Professional Officer's Name

______

Signature Signature

______

Agency Fax NumberAgency Email Address

______

Agency Phone NumberAgency Website Address

Section 1: Organization Overview

Mission Statement:

Year last updated:______

Brief History of Agency:

Year established
in community:______

Agency Service Area (check all that apply):

☐Garfield ☐Grant☐Major☐Kingfisher☐Alfalfa☐Blaine☐Kay

☐Noble☐Logan☐Others: ______

Individuals employed by your agency:

Part A: ______+______= ______

Full TimePart-timeTotal

Part B:______+______=______

ManagementProgramTotal

10. Agency’s Fiscal Year: ______

11. Characteristics of your Board of Directors:

Men ______Native American ______

Hispanic ______

Caucasian ______

Women ______African American ______

Other ______

Board of Directors Information

Provide a roster of Board Membersidentifying officers, term of partnership, businessaddress, phone numbers and place of employment.

______

Click here to enter text.

Section 2: Program Justification/Community Need

Describe the need for this program in the community. Use as many pages as needed. Include measurable data (Census, State or Local Statistics, etc..), media reports, community stakeholder comments, or anything else you feel provides insight into the issue/need being addressed. Letters of support (for need) may be included.

C-1 / Program Name:
Click here to enter text. / Community ImpactCategory:
☐ Education ☐ Health/Safety ☐ Income
Program Goal & Target Population:
Click here to enter text.
Total Program Cost: $ ______ / United Way Funds Requested for this Program: $ ______
Section 3: Outcomes
Desired Outcome
Results you intend to achieve as a direct result of this program. These may relate to knowledge, skills, attitudes, values, behaviors, condition, or status. / Indicator
Specific items of information that track a program’s success on outcomes. / Target
Outcome goals for FY 2012 program / Data Source
What you are using to measure your data, i.e. survey, staff observation
Example: Students will improve their academic achievement / # and %of students that show improvement in test scores / Of the 100 students, 80/80%will show improvement in their test scores / Test scores
Youth survey

(Use additional sheets labeled C-2, etc.. for each program)

Additional Program Sheets can be downloaded at:

C-2 / Program Name:
Click here to enter text. / Community Impact Category:
☐ Education ☐ Health/Safety ☐ Income
Program Goal & Target Population:
Click here to enter text.
Total Program Cost: $ ______ / United Way Funds Requested for this Program: $ ______
Section 3: Outcomes
Desired Outcome
Results you intend to achieve as a direct result of this program. These may relate to knowledge, skills, attitudes, values, behaviors, condition, or status. / Indicator
Specific items of information that track a program’s success on outcomes. / Target
Outcome goals for FY 2012 program / Data Source
What you are using to measure your data, i.e. survey, staff observation
Example: Students will improve their academic achievement / # and %of students that show improvement in test scores / Of the 100 students, 80/80%will show improvement in their test scores / Test scores
Youth survey

(Use additional sheets labeled C-2, etc.. for each program)

Additional Program Sheets can be downloaded at:

VOLUNTEERS
The United Way of Enid & NW Oklahoma encourages all non-profits to engage volunteers to strengthen program impact and promote community involvement/ownership. List all volunteer opportunities throughout your agency’s various programs. (This information will be added to our website at and the 2-1-1 system)
Program / Duties of Volunteers
(brief description) / Volunteer Requirements
(age, ability, etc.) / Contact Person / Contact Number & Email
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
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POLICY ADVOCACY
Is your agency involved in any policy advocacy (local, state, federal) efforts aimed at impacting the population you serve (this might include advocating changes to Medicaid/Medicare procedures, community ordinances or practices, state or federal laws or rules): ☐ Yes ☐ No
If yes please list all efforts:
Brief Description / Population Impacted / Scope of Effect (local, state, national)
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
PARTNERSHIPS
Describe how you are involved/collaborate with each of the following partner
United Way of Enid & Northwest Oklahoma agencies:
Agency / Partnership
Booker T. Washington Center / Click here to enter text.
Red Cross / Click here to enter text.
Boy Scouts / Click here to enter text.
CDSA / Click here to enter text.
Consumer Credit Counseling / Click here to enter text.
YMCA / Click here to enter text.
Community Clinic / Click here to enter text.
Metro Commission / Click here to enter text.
Child Advocacy / Click here to enter text.
Hedges Speech & Hearing / Click here to enter text.
Girl Scouts / Click here to enter text.
RSVP / Click here to enter text.
Salvation Army / Click here to enter text.
YWCA / Click here to enter text.
Youth & Family / Click here to enter text.
Catholic Charities / Click here to enter text.

Section 3: Financial Information

FINANCIAL

Amount of Venture funds requested:

Total Project Amount:

What are the other income sources?

Source / Amount

How will this project be funded the next year?

Include a copy of a detailed total proposed budget for this project (include both income and expenses).