United Way East TN Highlands - Helene Response Funding Application
For Non-Profit Organizations seeking financial assistance for Hurricane Helene response.
On behalf of United Way of East TN Highlands, I want to extend our deepest gratitude for your incredible efforts in response to Hurricane Helene. Your dedication to supporting our communities in Northeast Tennessee has been invaluable, and we truly appreciate everything you’ve done.
If your organization is actively working with a Long-Term Recovery Group, please continue completing this form to be considered for funding opportunities. If you are not yet connected, we would love to help facilitate that connection to ensure the greatest impact in our communities. Please reach out, and we will be happy to assist. Contact: Mary Thomas | mary@unitedwayetnh.org. Thank you again for your commitment and service. We look forward to working together in the recovery and rebuilding efforts ahead.
Leslie Dalton | President/CEO | United Way of East TN Highlands | ldalton@unitedwayetnh.org | 605 W Walnut #2, Johnson City, TN 37601 | 423.220.1229 | www.unitedwayetnh.org
Is your organization already working with a Long-Term Recovery Group?
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Yes
No
Organization Name
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Organization Address
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Contact Name: First
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Contact Name: Last
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Contact Title
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Contact Phone Number
If you see this box. please ignore
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email Address
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If you see this please ignore
Email
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example@example.com
How many years has your organization served the community?
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Tax Status: e.g., 501 c(3), etc.
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Organization EIN#
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If you are not already funded by United Way East Tennessee Highlands, please attach IRS Form 990, 990EZ or 990T (whichever is applicable).
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Requested Funding Amount
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$5,000
$10,000
$20,000
$50,000
Other
Timeline for Completion of Project
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What county/counties will you be serving with these funds?
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Carter
Cocke
Johnson
Greene
Unicoi
Washington
If you are providing services in multiple counties, please include a breakdown of the amount of funding that will be used in each county.
Is your organization already working in disaster recovery efforts in the counties checked above?
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Yes
No
LONG-TERM RECOVERY (check all that apply):
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Case Management
Legal Services
Medical and Health Services
Mental Health/Crisis Counseling
Permanent Housing
Rebuilding/Construction
Project Name
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Please describe in 200 words or less what will your organization do with disaster relief funding?
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0/200
Is your organization willing to serve on a committee for a Long Term Recovery Group in your service county?
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Yes
No
Is your organization willing to maintain accurate client records through our shared database for client intake and referral?
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Yes
No
Is your organization willing to file necessary Financial Reports with the TN Secretary of State's Office if applicable.
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Yes
No
In addition to your Funding Request: What else do you need to be more effective and efficient with your efforts? (Please share openly and candidly with us.)
Please upload documents supporting your request - Including invoices, receipts, estimates, etc.
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