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Chatham County, NC

info@chathamnc.org

12 East Street, Pittsboro, NC, 27312, US

Form Section 1

Chatham County and United Way Funding Application 2018/2019

Agency Information

Form Section 2

Chatham County and United Way Funding Application 2018/2019

Section 1: General Information

Please answer all of the following questions for the funding year requested.



List the facilities you operate within Chatham County, along with their physical address.

Add Another Address


The amount below is the total monetary equivalent of volunteer hours donated to your agency. This was calculated using the most current estimated dollar value of volunteer time of $23.07/hour and the total number of volunteer hours that you entered in Question 8 above:

Form Section 3

Chatham County and United Way Funding Application 2018/2019

Section 2: Certification Questions

Whether you are requesting funding from United Way, Chatham County or both, two copies of all required certification documents must be submitted to the United Way office by 5:00 p.m., Wednesday, February 28, 2018.

Chatham County Certification Requirements
United Way Certification Requirements

Please label each document with the appropriate number in the top right-hand corner. Certification documents may be mailed to PO Box 1066, Pittsboro, NC, 27312 or delivered to the United Way office at 72 Hillsboro Street, Suite 202 in Pittsboro.

If a certification attachment cannot be submitted at this time, please submit an explanation as to why on letterhead and signed by the director. A projected date for submission of the required document should also be included. This letter of explanation should be submitted in place of the hard copy attachment and its certification number should be written in the top right-hand corner. 


C-1a. Annual Audit or Financial Review
An audit is required by both Chatham County and United Way for agencies with annual revenue of $300,000 and over. For agencies with annual revenue of less than $300,000, a financial review by an independent CPA is required. For agencies with annual revenue of less than $50,000, a financial analysis will be administered by staff. 

C-1b. Management Letter (If Applicable)

C-1c. Management Response (If Applicable)

C-2. Annual Line Item Budget
List all revenue and expenses for the prior year actual, current year budget, current year estimated and next year requested using the required budget template. Project year-end totals for "current year estimated." Provide an explanation for any variance between the last two years of more than 10%. Chatham County and United Way require your budget to balance, which means that total revenue and expenses should equal each other.

CLICK HERE to open the required template. Please save it as an excel file, enter all requested budget information, save again and upload the file in excel format at the bottom of this page. Also be sure to submit two hard copies.

C-3. NC Solicitation License or Letter of Exemption

C-4. IRS Form 990 (most recent filed)

C-5. Board Roster with Names, Addresses and Professional and/or Community Affiliations

C-6. Organizational chart of the Agency by position and number of hours worked per week

C-7. Code of Ethics and/or Conflict of Interest Policy

The following items (C-8 through C-12) should only be submitted if the agency is applying for the first time or if their Board has revised them since December 31, 2016:

C-8. Financial Reserves Policy

C-9. IRS 501(c)3 Letter of Tax Exemption

C-10. Non-Discrimination Policy

C-11. Articles of Incorporation

C-12. By-Laws

You have not uploaded a file. Please upload a file to continue.

Required Signature Pages: Please print, sign and return the required signature pages, as applicable, to the United Way office with the Certification Documents listed above. 

Chatham County Certification 
United Way Certification
Agreement that Information May be Shared

 

Form Section 4

Chatham County and United Way Funding Application 2018/2019

Section 2: Certification Questions

Financial Certification Questions

Click here for instructions for calculating FRA.

For more information on how to obtain or renew a NC Solicitation License, click here.

Form Section 5

Chatham County and United Way Funding Application 2018/2019

Section 2: Certification Questions

Legal Certification Questions

Form Section 6

Chatham County and United Way Funding Application 2018/2019

Section 2: Certification Questions

Governance Certification Questions

You have not uploaded a file. Please upload a file to continue.

You have not uploaded a file. Please upload a file to continue.

Form Section 7

Chatham County and United Way Funding Application 2018/2019

Section 2: Certification Questions

Human Resources Certification Questions

Form Section 8

Chatham County and United Way Funding Application 2018/2019

Section 3: Chatham County Program Request

Please CLICK HERE to open the required allocation budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your Chatham County request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the County request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

 

You have not uploaded a file. Please upload a file to continue.

7. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

15. Which of the county's desired results does the program address? (800 characters) CLICK HERE for Examples

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Form Section 9

Chatham County and United Way Funding Application 2018/2019

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budget must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Section 3: Chatham County Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your Chatham County request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the County request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

7. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

15. Which of the county's desired results does the program address? (800 characters) CLICK HERE for Examples

Form Section 10

Chatham County and United Way Funding Application 2018/2019

Continue to the next page by clicking the "Next" button.

Continue to the next page by clicking the "Next" button.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template. 

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budget must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Form Section 11

Chatham County and United Way Funding Application 2018/2019

Continue to the next page by clicking the "Next" button.

Continue to the next page by clicking the "Next" button.

Continue to the next page by clicking the "Next" button.

Continue to the next page by clicking the "Next" button.

Continue to the next page by clicking the "Next" button.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.

Form Section 12

Chatham County and United Way Funding Application 2018/2019

To submit your application click the "Submit" button.

To submit your application, click the "Submit" button. 

To submit your application, click the "Submit" button.

To submit your application, click the "Submit" button.

To submit your application, click the "Submit" button.

To submit your application, click the "Submit" button.

To submit your application, click the "Submit" button.

To submit your application, click the "Submit" button.

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

You have not uploaded a file. Please upload a file to continue.

Please CLICK HERE to open the required Program Budget template.

Revenue Section: Please list ALL revenue for this program. In the 'Notification Status' column indicate:

  • If funding is approved- "Approved, Date"
  • If funding is pending- "Pending, Anticipated Notification Date"

Please also indicate whether your United Way request is fulfilling a required match for the funding sources you list by indicating 'Yes' or 'No' in the 'Match' column. If yes, please specify the amount of the United Way request that will fulfill the required match. 

Expense Section: Please list all expenses for this program.

*Please Note: "Current Year" and "Next Year Projected" budgets must balance.

You have not uploaded a file. Please upload a file to continue.

9. Please identify the number of clients served by this program for the current year by geographical area. (You will need to estimate the number served through the end of the current year.)

10. Enter the total number of clients served by this program for the years listed below:

13. Describe the extent to which this program serves a critical need identified by the United Way of Chatham County Community Needs Assessment. (1,000 Characters)

14. List up to three goals and measurable objectives for the program for the 2018/2019 funding year, using the following format:

Goal: To [provide or produce what service or product] for [clients or target market served] in order to [describe the outcome].

Objective: An [increase or decrease] in [what aspect of the goal statement] by [x%] from [current measure] to [projected measure] toward a benchmark of [long-term goal].


Example:
Goal: To provide spay/neuter surgery at a cost of $20 to low-income Chatham County residents in order to decrease the intake of animals at the Chatham County Animal Shelter.

Objective: To decrease the intake of cats at the animal shelter by 5% from 700 to 665 toward a benchmark of 200.


Please Note: You will be required to report on each of these outcomes on January 15, 2019 (for 7/1/18 to 12/31/18) and July 15, 2019 (for 1/1/19 to 6/30/19). Receipt of funds obligates agency to submit these reports.