COVID-19 Phase III Grant Application
Questions? Call the United Way Office at 260-927-0995 or Email Chelsea at chelsea@unitedwaydekalb.org
Applicant Name:
*
First Name
Last Name
Organization Name:
*
Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Amount Requested:
*
in Dollars and Cents
What will your focus area be?
*
Example: Rent/Mortgage, Utilities, Food, Shelter, Medical, Childcare, etc.
How will funds be used?
*
Please be specific.
How will you ensure that donor dollars are safely distributed?
*
Please include required documents and proof of need.
Is this program new due to the COVID-19 pandemic?
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YES
NO
How was the need identified or what data was used to confirm the need?
*
Be specific.
Has your organization applied for a small business loan through the CARES Act?
*
YES
NO
WE PLAN TO
If answered "yes" to the previous question, has your organization been awarded funds?
*
YES
NO
STILL WAITING
N/A
Have you requested funds for this purpose from other funding organizations?
*
YES
NO
WE PLAN TO
If answered "yes" to the previous question, please complete the following:
Organization Name
Amount Requested
Date Requested
Status
1
2
3
4
5
Are you willing to complete the following requirements?
*
Complete a final grant report on how funds were used to meet the identified need(s) once funds are expended as required by the United Way of DeKalb County.
Collect the following documents for those requesting rent, mortgage, and utilities (Letter from the Township Trustee & document showing balance owed from bank, landlord, utility company, etc.)
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Signature
*
Date
*
-
Month
-
Day
Year
Date
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