Request for Application - Healthy Community 2026-27

FY2026-27 Request for Applications Healthy Community
Part I: APPLICANT AGENCY INFORMATION
A. General Agency Information
Applicant Agency Legal Name: *
Main Administrative Address: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Phone Number: *
Please enter a valid phone number.
Extension
Agency Website: *
CEO/Executive Director: *

First NameLast Name
Office Phone Number: *
Please enter a valid phone number.
Extension
Email Address: *
example@example.com
Federal Identification Number*
12-1234567
Applicant Agency Fiscal Year *
Beginning (mm/dd)
Ending (mm/dd)
B. Certification of Accuracy and Compliance
I do hereby certify that all facts, figures, and representations made in the application are true and correct. Furthermore, all applicable statutes, terms, conditions, regulations and procedures for program compliance and fiscal control will be implemented to ensure proper accountability. I certify that the funds requested in this application will not supplant funds that would otherwise be used for the purposes set forth in this program and are a true estimate of the amount needed to operate the proposed program. The filing of this application has been authorized by the contracting entity and I have been duly authorized to act as the representative of the agency in connection with this application. I also agree to follow all Terms, Conditions, and applicable federal and state statutes.
Print Authorized Official's NameAuthorized Official's Title
Signature*

Clear
Date*

MonthDayYear
Date
C. Organizational Background
1. Provide a concise description of the Applicant Agency, including its history, years of operation, general mission statement and primary services provided. (Up to 2 points)*
2. How does the Applicant Agency support United Way of Broward County? (Up to 2 points)*

Workplace Fundraising CampaignFacility ToursSpeaker's Bureau MembersEvent SupportN/AOther
3. Has the Applicant Agency been a defendant in any litigation or regulatory action in the last three (3) years? (Up to 2 points)*

YesNo
If yes, provide a brief explanation of each instance.
4. Is the Applicant Agency accredited? (Up to 2 points)*

YesNo
If yes, please include the name of the accrediting body, the level of accreditation, and the time period, if applicable.
ORGANIZATIONAL ATTACHMENTS

Organizational Attachments A-K. Templates for attachments B, D, F, G, and H are provided below.
Enter link to UWB Website for downloads
Attachment A - Audited Financial Statement(s): Must be included as Organizational Attachment “A”. Applicant Agencies are required to submit their audited financial statements for the most recently completed fiscal year or the previous fiscal year if the most recent one ended within 180 days of the due date of this Application. Smaller agencies (those agencies with annual revenues less than $300,000) must submit unaudited compiled financial statements prepared by a CPA. *

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Attachment B - Applicant Agency Verification: Complete and attach the two (2) page form provided above as Organizational Attachment “B”. Requires original signature duly verifying the authority of the signatory to act on behalf of the Applicant Agency for this Application and certifies that all representations made in the Application are true and correct. *

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Attachment C - Certificate of Corporation: Must be submitted as Organizational Attachment “C”. The Applicant Agency is required to attach a printout of the Public Inquiry page from the Corporations Online, (www.sunbiz.org), dated within twelve (12) months of the due date of this RFA, stating that Applicant Agency is active. In the alternative the Applicant Agency may submit a copy of its Certificate of Corporation from the Secretary of State, State of Florida certified and dated by the Secretary of State within twelve (12) months of the due date of this RFA. This Certificate must state on its face that the Applicant Agency is active. Please note that a copy of the Articles of Incorporation, acknowledgement of Annual Reports, or any similar document DOES NOT meet the requirements of this section. *

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Attachment D - Current Drug Free Work Place Certification: Complete and attach the two (2) page form provided as Organizational Attachment “D”. This certifies that the Applicant Agency will provide a drug-free workplace. Notarized original signature required.*

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Attachment E - IRS determination of 501 (c) (3) nonprofit status must be included as Organizational Attachment “E”.*

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Attachment F - Client Non-Discrimination Policy: A sample policy is provided above. Include the Applicant Agency’s current policy as Organizational Attachment “F”. The Applicant Agency will not engage in or commit any discriminatory practice in violation of the Broward County Human Rights Act. Original signature required.*

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Attachment G - Current Equal Employment Opportunity Policy: A sample policy is provided above. Include the Applicant Agency's current policy as Organizational Attachment "G". *

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Attachment H: Current Americans with Disabilities Act Policy: A sample policy is provided above. Include the Applicant Agency's current policy as Organizational Attachment "H".*

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Attachment I: Include a direct line Organizational Chart showing where this program would function within the Applicant Agency if the requested funds are awarded. The Organizational Chart should be attached to this Application as Organizational Attachment “I”. *

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Attachment J: Not-for-Profit organizations must include a list of the Applicant Agency’s Board of Directors, and/or Advisory Board, including their affiliations, phone numbers, email addresses, and offices held within the Board as Organizational Attachment “J”.*

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Attachment K - 211 Organizational Profile must be attached as Organizational Attachment "K". An example is provided above. The Organizational Profile can be obtained by visiting the 211 website at www.211-broward.org*

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Part II: PROGRAM INFORMATION
A. Program Information
Program Name: *
Funding Category:*

Health and Wellness In or Out of Home Care (including medical and preventive services)Health and Wellness Care Coordination
Funding Request ($):*
Is this program currently funded by United Way Broward?*

YesNo
B. Application/Program Contact Information
Program Contact Name: *

First NameLast Name
Program Contact Title: *
Program Contact Phone Number: *
Please enter a valid phone number.
Extension
Program Contact Email Address: *
example@example.com
C. Program Location(s)
Please provide program location(s). Additional entries can be made as needed once filled in.*
For Additional Location, please check box below

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Enter additional location
Please list any additional locations here:
D. Program Summary
Please summarize the proposed program in 500 words or less, including the program title and requested funding amount. Please provide an overview of the program's key components, target population, numbers to be served, geographic area, and proposed outcomes. (Up to 5 points)*

0/500
E. Statement of Need
Provide a narrative detailing the geographic area proposed, the target population to be served, and the service location(s). Provide a detailed overview of the condition/problem/gap in services that your proposal will address and why the funding is needed. The statement should include city, school, and/or neighborhood statistics regarding the identified issue. (Up to 30 points)*

0/2500
F. Evidence Based Model and Program Plan
Please provide a detailed description of the proposed model with supporting evidence. Describe client eligibility and how the population will be recruited and retained. Describe the proposed service schedule (days, hours, etc.) and dosage (frequency and duration). Please provide a detailed staffing plan that includes: positions, education requirements, experience level, duties of the position, and the percentage of time devoted to your proposed program model. (Up to 30 points)*

0/2500
G. Evaluation Plan
Describe your proposed evaluation processes. Please provide an overview of your proposed outcomes using a “Results Based Accountability” framework and your target goals for each. Describe the measurement tools you intend to employ. Describe the proposed data collection methodology and data collection points. (Up to 15 points)*

0/1000
H. Organizational Capacity
Describe the agency’s experience with providing the proposed service. Describe the agency’s experience in working with the targeted population. Please provide an overview of key staffs’ experience with providing the proposed service to the target population. Address how and why the agency is uniquely qualified to provide services in the geographic area proposed. Please provide a detailed overview of the agency’s cultural and linguistic competencies. Please address whether the program or agency has been monitored by UWB or other funder within the last 12 months and the results. (Up to 25 points)*

0/1000
I. Collaboration and Coordination
Describe the agency’s existing programmatic and any other relevant collaborations, partnerships, or coordination of services. Explain the agency’s capacity to leverage other services, funding, and/or resources. (Up to 10 points)*

0/1000
PROGRAM ATTACHMENTS

Program Attachments A-D. Templates for attachments A, B, and C are provided below.
Enter link to UWB Website for downloads
Attachment A: Staff Information: Must be included with Application as Program Attachment “A”. List all positions and the number of each, that will be providing direct and support services. Include the job title (which should match your budget narratives), minimum education, training and experience requirements, primary duties, and the percent of each position’s time that will be devoted to this program & funded by UWBC. (Up to 5 points)*

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Attachment B: Budget Detail and Summary: Complete and attach the budget form provided as Program Attachment "B". Provide detail of the annual expenses related to the proposed program on the Budget Detail Document (Tab 1) and a summary on the Budget Summary Document (Tab 2). Please note that the budget detail will transfer to the budget summary automatically. (Up to 5 points) *

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Attachment C: Performance Measures Matrix: Complete and attach form provided above as Program Attachment “D”. (Up to 5 points)*

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Attachment D: Please submit any monitoring reports and/or program evaluation reports for proposed programs that are currently funded by UWBC or any other funder.

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FY2026-27 Request for Applications Healthy Community

Part I: APPLICANT AGENCY INFORMATION

A. General Agency Information

B. Certification of Accuracy and Compliance

C. Organizational Background

ORGANIZATIONAL ATTACHMENTS

Part II: PROGRAM INFORMATION

A. Program Information

B. Application/Program Contact Information

C. Program Location(s)

D. Program Summary

E. Statement of Need

F. Evidence Based Model and Program Plan

G. Evaluation Plan

H. Organizational Capacity

I. Collaboration and Coordination

PROGRAM ATTACHMENTS