Letter Of Intent 2025-2026

Funding request for July 1, 2025 to June 30, 2026

**Please note that funding requested in the letter of intent will be the maximum amount of funding allowed to be requested on the application. Please refer to the graphic below to review the HKUW Application and Approval process.
Letter Of Intent:

Agency Information & Qualification Responses
Agency Name: *
Agency Address: *
Agency Phone Number: *
Format: (000) 000-0000.
Person Completing Letter of Intent*
Executive Director Name: *
Executive Director Email: *
YesNo
Most recently completed fiscal year ended on Date* .
For Annual Agency Budgets of $50,000 and below, agencies must submit a financial compilation.For Annual Agency Budgets between $50,001 and $100,000, agencies must submit a copy of their IRS 990.For Annual Agency Budgets between $100,001 and $250,000, agencies must submit a copy of their Financial Review.For Annual Agency Budgets above $250,001, agencies must submit a copy of their Financial Audit.

Letter Of Intent:

Program Overview
Program Name: *
Request Amount $: *
Primary Contact:*
Phone Number:*
Format: (000) 000-0000.
Email:*
example@example.com
Name of Chair/President of Board of Directors:*
Mailing Address for Chair/President of Board:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Letter Of Intent:
Conduct an HKUW Campaign among staff, board, and/or volunteersConduct a special fundraiser which benefits HKUWVolunteer at a HKUW Fundraising event in an HKUW an/or Agency capacity
Partner Agency Campaign Coordinator Contact:*

First NameLast Name
Partner Agency Campaign Coordinator Contact Email:*
example@example.com
Partner Agency Campaign Coordinator Contact Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Marketing/Media Agreement
Reporting Agreement
Counter Terrorism Compliance

In compliance with the spirit and intent of the USA PATRIOT Act and other counter-terrorism laws, Heart of Kentucky United Way requests that each funded partner ("organization") certify that it is in compliance with Heart of Kentucky United Way and the United Way of America's ("UWA") compliance program.
- This organization is not on any federal terrorism "watch lists", including the list in Executive Order 13224, the master list of specifically designated nationals and blocked persons maintained by the Treasury Department, and the list of Foreign Terrorist Organizations maintained by the State Department.
- This Organization does not, will not, and has not knowingly provided financial, technical, in-kind, or other material support of resources* to any individual or entity that is a terrorist or terrorist organization, or that supports or funds terrorism.
- This Organization does not, will not, and has not knowingly provided or collected funds or provided material support or resources with the intention that such funds or material support or resources be used to carry out acts of terrorism.
- This Organization does not, will not, and has not knowingly provided financial or material support or resources to any entity that has knowingly concealed the source of funds used to carry out terrorism or support Foreign Terrorist Organizations.
- This Organization does not re-grant to organizations, individuals, programs and/or projects outside of the United States of America without compliance with IRS guidelines.
- This Organization takes reasonable. affirmative steps to ensure that any funds or resources distributed or processed do not fund terrorism or terrorist organizations.
- This Organization takes reasonable steps to certify against fraud with respect to the provision of financial, technical, in-kind or other material support or resources or resources to terrorists and terrorist organizations.
*In this form, "material support and resources" means currency or monetary instruments or financial securities, financial services, lodging, training, expert advice or assistance, safehouses, false documentation or identification, communications equipment, facilities, weapons, lethal substances, explosives, personnel, transportation, and other physical assets, except medicine or religious materials.
Name & Title*
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Funding request for July 1, 2025 to June 30, 2026

Letter Of Intent:

Letter Of Intent:

Letter Of Intent:

Letter Of Intent:

Select ONE Goal & Strategy

Letter Of Intent:

Marketing/Media Agreement

Reporting Agreement