United Way of Trumbull County 2024-2025 Request for Funding

Request for Funding

PY 2024-2026
Applicant Agency*
d.b.a., if different from above
First Name President/Executive Director *
Last Name President/Executive Director *
President/Executive Director Phone Number*
Please enter a valid phone number.
President/Executive Director Email*
example@example.com
First Name, Board Chair*
Last Name, Board Chair*
First Name, Proposal Contact (if different from Pres./ED)
Last Name, Proposal Contact (if different from Pres./ED
Proposal Contact Email (Confirmation Email will be sent here)
example@example.com
Tax Exempt ID Number/EIN*
IRS Determination Letter Date*

MonthDayYear
Date
Primary Agency Address*
Address Line 2
City*
Zip*
Mission of Agency*
Describe any significant organizational changes in the last 12 months. (Leadership, staffing, new or cut programs, funding, etc.) If there are none enter N/A. *
Organization Financial Information
Fiscal Year End: *
Date: MM/DD
% of United Way's portion of total budget*
2023 Year End Financial Statements*

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Organization's Affiliation
Is your organization affiliated with any national or state organizations or initiative?*

YesNo
If yes, please specify each affiliation and explain the distinct role your agency plays in the organization or initiative.

Program Data
Program Title*
Has this program received funding from United Way of Trumbull County previously?*

YesNo
Amount of this request*
Geographic area served by this program*
Brief demographic description of population served by this program*
Which priority does the program focus on?

Select one or two options that fit your program.
Learn Well/Education
Earn Well/Financial Stability
Stay Well/Emergency Assistance and Basic Needs
Program Summary
Statement of Need*
Summary description of overall program *
Describe how the goals and objectives of this program meet your organization's mission and strategic plan*
Definition of a unit of service (must be clear and quantifiable such as a meal, a coat, an hour of mentoring, etc.)*
How many units of service are you projecting for 2024? *
What would a $1,000 donation to this program support (specifically as it relates to units of service)?*
Will the organization collaborate with anyone on this particular program?*
In your experience, what is the percentage of repeat clients?*
In your experience, what is the percentage of new clients?*
Success Story: Detail specifics on how an individual or family has been helped. How has this program changed a client's life?*
Upload a photo reflective of this success story.

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Do you have permission to use the real names/photos of the client(s) in the photo*

YesNoN/A

Revenue/Support*

	Total Program	% of Budget
Grants
Contributions
Affiliate Orgs/Non-Govt Contracts (Describe in narrative)
United Way of Trumbull County
Other Federated Campaigns (described in the narrative)
Membership Dues
Sponsorships
Admissions
Other United Ways
Other Revenue
Total Revenue/Support

Expenses*

	Total Program	% of Budget
Salaries
Employee Benefits, Taxes
Affiliate Orgs. or Contracts (describe in narrative)
Professional Fees
Equipment, Supplies, Materials
Evaluations
Other
Total Expenses

Program Financial Narrative
How will United Way dollars be used? *
Enter all other anticipated funding for this program, including earned revenue, in-kind support, special events, fundraisers, etc.

Age Demographics*

Gender Demographics*

Race/Ethnicity Demographics*

Most recent 990*

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Most recent Reviewed or Audited Financials*

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I certify that the information submitted in this request for funding is true and correct to the best of my knowledge*
President/Executive Director Signature*

Clear
Should be Empty:

Request for Funding