Community Investment Application July 2026

Community Investment Grant Application

2026-2027 Funding Period
Directions: Please fill out the application in full.
- You will be able to save and review the application before submitting.
- You will be able to print a copy of the application for your own records.
- You may upload more than one document in each upload location.
- There is no file size limit for minimum or maximum sizes
- Only upload documents that are asked for by the application.
- This application will let you know when errors, such as a missed upload, are made.
- The application will not let you proceed to the next page unless errors are fixed.
- Upon clicking submit, you will be redirected to the thank you page.
- If you don't get redirected, check your application for errors.
- Some questions have word limits; you do not have to meet these limits, but you can not exceed the specified limits.
If you have questions about this application or the Community Investment process, please contact Sandy Leavell M-F 8:30-4:30, sleavell@unitedwayroane.org or call 865-882-7711.
Eligibility Criteria
• Current registration as a Charitable Organization with Tennessee Secretary of State or has current exemption.

• Program is either located in and/or serves Roane County, TN

• Tax-Exempt Status under section 501(c)3 of Internal Revenue Code or has
a fiscal sponsor that is 501(c)3.

• Board of Directors meets regularly as directed by IRS & organization's bylaws.

• Organizations must have independent audit, review, compilation, or letter explaining why not based on the following annual revenue ranges:
- greater than $1 million: independent audit
- $250,000-$1 million: independent audit, review or compilation
- less than $250,000: no audit or review needed
• Program supports one of our four pillars of service: Healthy Community, Youth Opportunity, Financial Security or Community Resiliency.

• Capacity to report measurable, qualitative & quantitative outcomes.

• Agency must be in existence for at least 3-years or associated with or a member of one that has been.
* If funding is aproved, reciepent must adhere to Partnership Agreement & report deadlines.

* Funding does not extend to individuals, fundraisers, capital campaigns, endowments, sponsorships, marketing opportunities, or sports events.
Community Investment Grant Application

2024 Funding Period
Today's Date*

MonthDayYear
Date
Name of organization*
Address*

Current physical address

mailing address if different from above

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a phone number.
Website
Year Organization Founded*
IRS Tax ID number (EIN)*
IRS 501(c)3 Determination Letter (Proof of registration or exemption)*

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State registration or exemption letter from the State of Tennessee; Division of Charitable Solicitations.*

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Contact person*
Contact person's phone number*
Please enter a valid phone number.
Email*
example@example.com
What is your organization's mission?*
Does your organization use another organization for fiscal management or administration? If yes, please provide the contact information.

NoYes
Fiscal Management information if you answered Yes above.
Please indicate where grant awards should be mailed*

Organization mailing address listed aboveOther
Fiscal Agent Name and address if you answered "other" above.
Is the organization an audited federal and/or state government entity?*

YesNo
Provide a 3 sentence description of the Organization.*
This may be used on our website and printed material if the organization is awarded funding.
Section 2

Amount requested and certification
Total award amount you are requesting.*
What will be the impact if your funding request is not fully funded?
1. In compliance with the USA PATRIOT ACT and other counterterrorism laws, I certify that all RCUW funds will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes, and executive orders.
2. I certify that an active and responsible governing body directs the organization named in this application whose members have no material conflict of interest and who all serve without compensation; that publicity and promotional activities are based on actual programs and operations; and that the organization is chartered or incorporated under the State of TN.

I certify that the information provided for this application is true and accurate and either has been or will be shared with the entire Board:
Organization Executive Signature*

Clear
Printed Name*
Date*

MonthDayYear
Date
There are Save points located at each major section throughout the application. Click the SAVE button.

Please remember to SAVE and make sure you have the link before moving forward. Click the get share link as it is immediate and does not have to send to email. It will copy to your clipboard; paste it in a notepad or Word Document and save it for returning to the application.

When saving: If you have a jot forms account and are logged in, the email will go to your jot forms account email. Otherwise the application should prompt you to enter an email address. Please make sure that the email goes through before you close the window. If you don't have the save link, you will not be able to get back to where you left off.

Section 3

Recently funded Partners
Have you received funding from Roane County United Way (RCUW) in the recently completed 12 month period?*

YesNo
If you received funding from RCUW in the recently completed 12-month period, what were the service title (s)?
If you received funding from RCUW in the recently completed 12-month period, provide the outcome results based on your description used on your previous application for the services that were funded.

Section 4

Financial Stewardship and Managerial (Governance) Stewardship. See instructions for requirements on submitting financial documentation with application.
Describe your process for fraud prevention:*

0/1000
Describe your board of directors’ involvement in your organization governance, budgeting, planning and fundraising. *

0/500
How often does your board meet?*
How often and who reviews the organizations financial information and assets? *

0/500
Does the organization have bylaws and/or other documents describing operations?

YesNo
If yes, provide a brief description of the general areas covered within the document describing operations.

0/500
Provide insight into changes that are affecting your organization. Describe changes or what is occurring that affects your organization’s financial security or insecurity?*

0/1000

Section 4 continued

file uploads
Please upload your most recently completed audit. If your organization is an audited federal and/or state government entity, the Financial Review Panel may elect to deem the audit review as satisfactory completed without reviewing the audit.*

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List of current Board of Directors*

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Board Meeting minutes (3 most recently held meetings)*

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Please provide the last 3 years' 990's if gross receipts are greater than $50,000.00, AND funding request is greater than $10,000. (Only 1 year is required if funding request is less than $10,000.)
990 year 1

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990 year 2

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990 year 3

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Please provide 3 years of financial information

Only 1 year is required if funding request is less than $10,000.
Please upload the most recent 3 years of Profit & Loss Statements.*

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Please upload the most recent 3 years of Balance Sheets & Cash Flow Statements .*

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Please provide the most recent 3 years of Annual Budgets. Please make comments on significant items.*

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Section 5 - Strategic Plan:
Does your organization have a strategic plan?*

YesNo
Upload your Strategic Plan.

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If you do not have a current plan, when will this be completed?

Section 6 - Collaboration/Partnership:
Please describe how your organization has engaged in partnerships or initiatives with other organizations to target underlying issues and changing conditions in the community to benefit a specific community population?*

0/1000
Please list all planned fundraisers for the coming year including the activity and when the fundraiser will take place:*

0/500

Section 9

Past Success
Provide 1 success story: This will be a narrative description of the service recipient’s success. The story should be about an actual person, not a program composite. This information helps reviewers understand the service (and any additional, related services) provided which affects the outcome and/or impact to the service recipient. Protect client confidentially by changing names and details. These stories may be shared with the community in fundraising efforts. RCUW may use this success story in promotional materials.*
Please list any additional comments related to your application that you feel are important for the Community Investment Committee in the area below:
I affirm that I have reviewed this application and, to the best of my knowledge, the information furnished is correct and provides full and fair disclosure of all information, revenue and expenditures of this organization. My Board President or Chair and my CEO/Executive Director is aware of this application.
Name of person completing this application*
Signature*

Clear
Note: You will have to click the Review Answers button to review your application. Once you do, the SUBMIT button will appear.
Should be Empty:

Community Investment Grant Application

Eligibility Criteria

Community Investment Grant Application

Section 2

Section 3

Section 4

Section 4 continued

Please provide the last 3 years' 990's if gross receipts are greater than $50,000.00, AND funding request is greater than $10,000. (Only 1 year is required if funding request is less than $10,000.)

Please provide 3 years of financial information

Section 5 - Strategic Plan:

Section 6 - Collaboration/Partnership:

Section 7 - Funding Request for Services

Service 1:

Outcome for service

Service 2

Outcome 2

Service 3

Outcome 3

Additional information

Section 9