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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

Physical Address *
Mailing Address *
Director Name *
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.

1. What is your fiscal year? *
2. What is your Total Agency Budget? *


5. Facilities You Operate *

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

Add Another Address

6. How many staff members work for your agency? *

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:

Total Monetary Equivalent of Volunteer Hours
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

Use the template provided above to upload C-2 (Annual Line Item Budget) in Excel format. *

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

1. Is the agency in compliance with its Financial Reserves Policy? *
2. Are there any reports of pending lawsuits, known fraud or embezzlement activity within the agency? *
3. What is the percentage of the agency's fundraising and administrative expenses? *

Click here for instructions for calculating FRA.

5. What is the expiration date of your NC Solicitation License? *

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

6. Is the Board insured? *
7. Does the Board review general liability insurance needs? *
8. What are the limits of liability? *
9. Is the staff bonded? *
10. Does the agency have insurance covering employee dishonesty? *
Form Section 6

Chatham County and United Way Funding Application 2018/2019

Section 2: Certification Questions

Governance Certification Questions

12. When last was the agency's mission revised? *
16. Do you maintain board minutes? *
17. Does your Board currently have a strategic plan that was created in the last 5 years? *
Please upload your strategic plan in PDF format *

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

18. Does your Board currently have a fundraising plan? *
Please upload your fundraising plan in PDF format *

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

19. Do you have job descriptions for your Board members that include fundraising responsibilities? *
20. Do you conduct an orientation for Board members? *
21. Are your personnel policies reviewed by the Board? *
22. Does your agency conduct a regular evaluation, certification or similar process by an external group for the programs you operate? *
Form Section 7

Chatham County and United Way Funding Application 2018/2019

Section 2: Certification Questions

Human Resources Certification Questions

23. Does your agency have personnel policies? *
24. Does your agency have job descriptions for each staff person? *
25. Does your agency have a performance review system? *
26. Is there an orientation program for agency staff and volunteers? *
Form Section 8

Chatham County and United Way Funding Application 2018/2019

Is your agency applying for Chatham County funding? *
Is your agency applying for United Way funding? *

Section 3: Chatham County Program Request

Please CLICK HERE to open the required allocation budget template.

4. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

5. Is the amount of funding requested for this program an increase over the amount requested for this program from Chatham County last year? *

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.

 

6. Using the above template, upload a Program Budget in Excel format. *

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.

14. Which category of need does your program address: (You may choose more than one) *

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.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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

Is your agency applying for funding from Chatham County for another program? *
Is your agency applying for funding from United Way? *
Is your agency applying for funding from United Way for another program? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

4. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

5. Is the amount of funding requested for this program an increase over the amount requested for this program from Chatham County last year? *

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.

6. Using the above template, upload a Program Budget in Excel format. *

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.

14. Which category of need does your program address: (You may choose more than one) *

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.

Is your agency applying for funding from United Way? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template. 

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

Is your agency applying for funding from United Way for another program? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

Is your agency applying for funding from United Way for another program? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

Is your agency applying for funding from United Way for another program? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

Is your agency applying for funding from United Way for another program? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

Is your agency applying for funding from United Way for another program? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.

Is your agency applying for funding from United Way for another program? *

Section 4: United Way Program Request

Please CLICK HERE to open the required Allocation Budget template.

6. Using the above template, upload a proposed Allocation Budget in Excel format. *

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

7. Is the amount of funding requested for this program an increase over the amount requested for this program from United Way last year? *

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.

8. Using the above template, upload a Program Budget in Excel format. *

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:

12. Indicate which United Way Funding Focus Area this program addresses: *

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.