United Way of Wells County Economic Relief Initiative Grant Application for Blackford or Wells Counties

United Way of Wells County Economic Relief Initiative Grant Application for Blackford or Wells Counties
Amount Requested *
County where funds will be used *
MUST be used for one of these two counties.
Organization Name *
Director Name *

First Name Last Name
Organization Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Grant Contact Name *

First Name Last Name
Grant Contact Phone Number *

Area Code Phone Number
Grant Contact Email *
example@example.com
Explain your request: What will you be doing with the funds? How many individuals do you expect to help in the next 30, 60, 90 days? How long do you expect these funds to last? How has COVID-19 impacted your budget? Be specific *
What are your expected outputs? *
Did your organization apply for PPP (Payroll Protection Program) through the SBA? *
Did you receive funding? How much? *
Have you received other funding to support this project? How much? (Donors, organizational reserves, SBA, etc) *
Program Name for which you are applying *
If awarded a grant, do you certify that you will abide by all United Way reporting requirements? There will be a report due within 30 days of expenditure of funds. *
Organizational Budget *

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Cancel of
Program Budget *

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Upload a .pdf copy of your program budget that outlines the anticipated income and expense for the entire project Cancel of
IRS 990 *

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Please upload .pdf copy of your most current IRS 990 Cancel of
IRS determination letter *

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Upload a .pdf copy of your 501c3 letter. Cancel of
If you have any questions or difficulties, please email Pamela@unitedwaywells.org
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