Be a United Way Hero Banner imageINITIAL - Small Opportunity Grant Application   -   Due March 1, 2024  

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FISCAL AGENT/FISCAL SPONSOR
FISCAL AGENT/FISCAL SPONSOR INFORMATION
Fiscal Agent/ Fiscal Sponsor Important Information

If utilizing a Fiscal Agent/Fiscal Sponsor United Way of Greater Lima will need to collect additional information as seen in the required documents section at the end of the form. These additional documents will replace some of the other documents previously required. United Way of Greater Lima will require all Agencies utilizing a Fiscal Agent/Fiscal Sponsor to provide a written agreement confirming the Fiscal Agent/ Fiscal Sponsor relationship. This agreement must include a statement regarding the Fiscal Agent's/Fiscal Sponsor's ability to retain discretion and control over the donated funds. In addition to the agreement United Way of Greater Lima will also require an annual accounting for all funds received from UWGL. This document will replace the previously asked for 990 and should show how and where the funds were used for the designated program.

A Fiscal Agent/Fiscal Sponsor must be a 501(c)3 nonprofit organization. Since Churches are granted automatic tax exempt status, they meet United Way of Greater Lima's requirements needed to serve as a Fiscal Sponsor.





MAILING ADDRESS









AGENCY INFORMATION





MAILING ADDRESS









Your 12 month accounting period.









(250 words or less)




(250 words or less)



AGENCY GOVERNANCE PRACTICES







%





(250 words or less)

OPTIONAL (250 words or less)
AGENCY PARTICIPATION IN UWGL ACTIVITIES


(250 words or less)
INTERNAL CAMPAIGN




%

$
Estimates are acceptable.

(250 words or less)

(250 words or less)
FINANCIAL OVERVIEW OF AGENCY
UWGL encourages financial stability in our partner agencies.  We encourage you to develop operating reserves and endowment funds as they indicate diversified and stable funding.  You are not penalized for healthy balances in these funds.  Reserves of 3-6 months of operating expenses are recommended.  Provide information based upon your most recently completed fiscal year.

$


$
(From Line 12 of Form 990, or Line 9, Part I of Form 990-EZ)

$
(From Part IX, Line 25(A) of Form 990, or Line 17, Part I of Form 990-EZ)

$

$
(From Part IX, Line 25(B) of Form 990, or Line 32, Part III of Form 990-EZ)

$
(From Part IX, Line 25(C) of Form 990, or if filing Form 990-EZ, from agency budget)

$
(From Part IX, Line 25(D) of Form 990, or if filing Form 990-EZ, from agency budget)

$

%

%
PROGRAM INFORMATION





CURRENT REQUEST FOR GRANT FUNDING FOR THIS PROGRAM

$

$

%

(250 words or less)
AREA OF IMPACT

Choose the one that best applies, even though it may not fit your program perfectly.



PROGRAM INFORMATION

(250 words or less)


(250 words or less)



(250 words or less)

(250 words or less)

(250 words or less)

(250 words or less)


(250 words or less)

(250 words or less)

(250 words or less)
PROGRAM OUTCOMES/IMPACT
Program Outcomes/Impact ANTICIPATED IN THE COMING FUNDING YEAR (July 1 through June 30)
HOW ARE PEOPLE'S LIVES IMPROVED BECAUSE OF YOUR PROGRAM SERVICES?

Measuring the success of your agency initiatives is an important part of effectively managing a program.  UWGL must be able to show our donors that their contributions are truly making a positive difference in our community.  Therefore, part of applying for funding is to offer evidence that what you are doing is effective. 

Below we ask you to share your desired outcomes for this program in the coming year.  Tell us how you hope to impact lives through the services you provide.  We require a minimum of two (2) outcomes, and a maximum of four (4).  

In March and September, we will ask you to report on your success at reaching your program goals when you complete the IMPACT REPORTS.
Outcome  Desired Data/Tools   Used to Track Progress Target # of Clients  Receiving  Service Target #  Achieving Desired  Outcome Target % Achieving Desired  Outcome
Outcome #1
Outcome #2
Outcome #3
Outcome #4

Optional (250 words or less)
REQUIRED DOCUMENTATION
United Way standards require specific documentation from its' partners.  Please upload the MOST RECENT version of all the following documentation.  In addition, please follow these instructions for uploading successfully.  
  • All attachments in pdf format should have portrait orientation and be sized to 8 1/2 x 11 only.
  • The file size should not exceed 35 MB.
  • If a document consists of multiple pages, it needs to be uploaded in one file.  Do not attempt to upload one page at a time on any question requiring upload.
  • The file extensions accepted by the system are pdf, doc, docx, xls, xlsx, ppt., pptx(PDF is PREFERRED.)
Download Forms Needed to Complete Application
Please visit www.unitedwaylima.org/agency-resources to download the following forms for submission.  BECAUSE THESE FORMS ARE PERIODICALLY UPDATED, PLEASE DOWNLOAD THE LATEST VERSION FROM THE WEBSITE RATHER THAN RELYING ON THE FORM YOU USED LAST YEAR.

     1.  USA Patriot Act Statement of Compliance
     2.  Program Budget Form (Required)
     3.  Optional Worksheet for Completing Program Outcomes
Upload Agency Information










You may include any documents you were unable to upload above, as well as anything else you feel is pertinent to your program.
Upload Program Information

Please complete the Program Budget Form (found at the link listed above) with the simplified financial budget of only the program for which you are requesting funding.

OPTIONAL (250 words or less)
AUTHORIZATION
I verify that I have reviewed the information provided and it is accurate and correct to the best of my knowledge.  I also verify that I have reviewed it with my Program Director and have received Board support/approval.