Food Pantry Coalition Grant Form

FOOD PANTRY COALITION ALLOCATIONS GRANT APPLICATION

Application Deadline - March 8, 2025
Food Pantry Coalition

A cornerstone of Henderson County United Way's Community Resiliency strategy is the formation of a Food Pantry Coalition composed of local pantries from each city/town within Henderson County. Food security is a basic need that is often the first indicator of more critical unmet needs of a family. Our goal is to engage pantry partners to help triage these clients and get them the assistance they need, supported by a fortified 211 Help Line service. The Food Pantry Coalition will be key partners during an emergency response or crisis situation. Establishing these services closer to each local community, helps overcome travel distances and transportation barriers that often prevent residents from receiving critical support and assistance during a crisis. As a Food Pantry Coalition network member, United Way will provide funding support to operate with necessary supplies and bandwidth to close the gaps of unmet needs, and strengthen our community readiness during an emergency.
Contact Information
Full Legal Organization Name*
Organization Website*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization President / Executive Director*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
E-Mail Address*
example@example.com
Contact Person*

First NameLast Name
Title*
E-Mail Address*
example@example.com
Phone Number*
Please enter a valid phone number.

Organization Information
501(c)(3)?*

YesNo
Hours of Operations*
Type here...
FEDERAL TAX ID EIN#*
File Upload - 501c3 Letter of Determination *

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File Upload - List of Board of Directors*

List of all officers, and/or Board of Directors. Include names, titles, addresses, email, contact numbers.
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Total # of Board Members
Total # of Staff
Organization Mission Statement
Description of Organization Programs
Does your Food Pantry participate in East Texas Food Pantry programs? Explain.
Does your Food Pantry provide referral services? Explain.
Is your Food Pantry listed in the 211 Service Provider Directory?
What other services does your Food Pantry provide?

Geographic Area Served
List of Towns/Cities and number served
Please Explain any Service Challenges or Gaps in Service experienced this past year?
We participate in the United Way Annual Campaign in the following ways:
Diversity Equity Inclusion
Total Organization Budget*
File Upload - Current Annual Budget *

Current year itemized report of anticipated revenue and sources itemized detailed report of all proposed usage of funds.
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File Upload - Balance Sheet Last Fiscal Year-end*

Balance Sheet reflecting all assets and liabilities as of the last fiscal year-end (include fund balances).
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File Upload - Profit & Loss Statement Last Fiscal Year-end*

Profit & Loss Statement itemized detailed report of all (revenues) sources and uses (expenditures) from each source during the last fiscal year and since last fiscal year-end.
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File Upload - Most recent IRS Form 990

Most recent IRS Form 990
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Funding Request
Program / Project Name
Total Program/Project Budget*
Requested Amount*
Awards are capped not exceed 10% of Project Budget
Percent of Organization Budget*
What else would you like the Allocations Committee to know about your program?
* Some additional information may be requested by HC United Way in order to process your application.

Agreement with Participating Members

For the purpose of sharing the joint fund to be raised by the Henderson County United Way, each member organization so sharing shall agree: a) Henderson County United Way works because of the collective sharing of resources by the members of the community. In that same spirit we expect agencies and programs assisted by United Way to participate in, and generously support those sponsored events and activities of the Henderson County United Way intended to further its mission in Henderson County. b) After being given full consideration and hearing to accept the apportionment of funds made to it by the Allocations Committee and approved by the Board of Directors. c) To cooperate with other social agencies in preventing duplication of effort, and in promoting effective service, efficiency, and economy of administration. d) To keep complete and regular books of accounts open to inspection by a representative of the Henderson County United Way. e) To file with the Henderson County United Way at the end of each fiscal year and otherwise upon request, a certified copy of a complete and satisfactory audit of all accounts and holdings of the organization, unless exempted by the Executive Committee of the Henderson County United Way. To submit to this organization such other reasonable information concerning finances, programs, etc., and in such form as the Board of Directors may require. f) Any agency can call upon the Henderson County United Way for portions of its budgeted financial needs in advance of the final distribution of general funds, by presenting to the Allocations Committee a formal written request for funds which the Henderson County United Way Board of Directors will evaluate. g) Annually, upon completion of the general fund drive, the Board of Directors shall appropriate all budgeted funds according to the approved budgeted needs of each agency, and shall direct the Treasurer to pay over to each agency its portions of such funds, less any advances which may have been made in accordance with paragraph f) of this section. The Board may advise the Treasurer to pay funds that the agencies are to receive in some manner other than one payment. h) As a condition to receiving funds from the Henderson County United Way we agree to make contact with potential volunteers, as well as our own board members, to help participate in and assist in with the 2025-2026 Henderson County United Way Campaign scheduled to begin September 2025.
We hereby certify the above Agency has agreed to abide by the Henderson County United Way Agreement with Participating Members.
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FOOD PANTRY COALITION ALLOCATIONS GRANT APPLICATION

Food Pantry Coalition

Contact Information

Organization Information

Funding Request

Agreement with Participating Members