United Way of Walworth County Grant Application 25' 26'

United Way of Walworth County Grant Application

Community Impact Grant for 2025-2026
Applicant Information
Organization Name and Legal Name (if different)
Primary Contact Name and Title/Position
Email
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Website
Amount of Funds requested. $500 minimum to $6000 maximum
The United Way of Walworth County Grant Dollars for 25’-26’ are $125,000.
Signature

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Eligibility Requirements

Please upload the following documents unless you have already submitted them for ARPA Phase 6.
W-9 Form: Upload a completed and signed W-9 form for your organization.

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IRS Letter: Upload your organization’s full IRS Non-Profit Determination Letter 4076 C or Letter of Association to show evidence of 501(c)3 or 501(c)19 nonprofit status

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DFI Registration: Upload an image (sample photo below) of your organization's current active license with the Wisconsin Department of Financial Institutions. CLICK HERE to locate your organization's credentials on the WI Department of Financial Institutions website and confirm your active status.

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SAM.gov Registration: Upload an image (sample photo below) of your organization's current active registration on SAM.gov showing your Unique Entity Identifier (UEI) number (formerly DUNS). *Note: You must be a registered user on SAM.gov to access this information.

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Grant Proposal
Describe who you serve in Walworth County and in what capacity.
How will these dollars impact those people?
Describe the purpose of the grant funding. How will the funds be used in the next calendar year?
Use narrative and budget if possible.
Will these funds be used in conjunction with other fundraising sources and is your organization impacted by federal grant changes?
If yes, please describe:
Include projected loss of funds if applicable.
Will you commit to providing a photo and a brief description of how the funds were used by February 15th 2026? *

Additional Questions
How does your organizations "Mission" align with the United Way's priorities to increase access to Housing, reduce Food Insecurity and increase access to Healthcare?
Are you partnering with other organizations to enhance your impact?
If yes, please describe the partnership:
How many residents of Walworth County does your organization support?
Residents
How many staff does your organization have?
Staff
How many volunteers support your organization on an annual basis?
Volunteers
Does your organization have a sustainability plan?
If yes, please describe:
How does your organization ensure equitable access to services?
Can you demonstrate an immediate need for these services in the community?
If yes, please describe:
Narrative and Data if applicable.
Does your organization participate in the Community Health Assessment or the Community Health Improvement Plan facilitated by Public Health and Walworth County Health and Human Services?

Scoring Rubric

Your grant application will be reviewed by a team of United Way of Walworth County board members and the executive director. They will assess your application using an internal scoring rubric to evaluate the quality and clarity of your responses. Your application will receive a score out of 100 points, which will help determine the percentage of funding your organization may receive based on need and your requested amount. Submission of an application does not guarantee funding.
Your ability to demonstrate need, how you affect the residents of Walworth County, how this funding helps you complete your mission, and how that mission relates to the priorities of Walworth County United Way are the major contributors to the scoring factor in each category.
Your application will be scored based on the following criteria:

5 points – Correct forms and completed application
5 points – Submitted eligibility documents or confirmed submission for ARPA Phase 6
50 points – Clear and concise answers in the Grant Proposal section
40 points – Clear and concise answers in the Additional Questions section
Should be Empty:

United Way of Walworth County Grant Application