2024-2026 Community Investment Grant Application1Organization Information2Contact Information3Organization Budget Information 4Program Information5Program Narrative6Program Demographics7Program Budget Information8Impact Information9Attachments10Consent Application IDPlease ensure you are logged in to SAVE and come back to your application. Applications are due no later than March 27th, 2024 at 4:00pm If you have questions about the application, we will be hosting an in person Q&A on March 1st from 9am-11am at the United Way of Bay County.Any current impact partners who have not stayed within compliance of United Way of Bay County Standards will not be considered for the next funding cycle. ie: Submitting reports on time, displaying partnership, etc.Organization Name*EIN Number*Organization Website Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your mailing address the same?*YesNoMailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Organization Phone*Your Organization's Mission Statement*Brief History of Organization*Contact InformationCEO/ Executive Director* First Last CEO/ Executive Director Phone*CEO/ Executive Director Email* Board Chair/ President* First Last Board Chair/ President Phone*Board Chair/ President Email* Contact Name* First Last TitleContact Phone*Contact Email* Organization BudgetPlease attach your organizational budget in PDF format for 2024 and include 2023 actuals.FileAccepted file types: pdf, Max. file size: 128 MB.Please Explain any surplus or deficit of Organization's budget or additional information that may be helpful in the review process.*Program InformationProgram Name*Impact Area*HealthEducationIncome StabilityAnnual funding amount requested*Has the amount requested increased or decreased from the last funding cycle?*IncreasedDecreasedNot ApplicableTotal Budget for Program*Percentage (%) of Program Budget this Request Represents*Which County or Counties Do You Serve with this Program?* Bay Saginaw Midland Gratiot / Isabella OtherIf Other Please SpecifyHas This Program Been Previously Funded by a Local United Way?*YesNoIf Yes, Please Specify Which Local United Way Bay County Saginaw County Midland County Gratiot & Isabella Counties OtherApproximate number of Bay County residents you expect this program to serve annually*If you do not receive the full amount of requested funding, how will this affect your program?*Please identify what the requested United Way funding will be spent on (salaries, materials, etc.).*Is this a Fee-Based Program?*YesNoIf Yes, Please ExplainIs this Program a Sliding Fee Scale?*YesNoIf Yes, Please ExplainIs There a Waitlist for the Program?*YesNoIf Yes, What is the Current # on the Waitlist?How do you plan to reach/recruit new participants?*How does the program utlitize volunteers?*Program NarrativeProvide a brief description of your program*Explain how your program aligns with United Way's goals and the needs in the community. (Add data points to support)*Describe the delivery of the program*Include your target audience, when, where and how the program will be implemented, and evidence based curriculum or best practice strategies for program design and delivery.What organization's do you collaborate with for this program, and how?*Are there other agencies who offer similar or complimentary services? If so, how do you collaborate?*What is your sustainability plan for this program? (after funding cycle)*Program DemographicsDemographics will be included in required annual reports. Priority for funding will be given to programs that serve populations traditionally underserved or disadvantaged and focus on advancing equity within our community.Age Range of Program Participants* Under 18 18-24 25-34 35-44 45-54 55-64 65 or AboveGender(s) of Program Participants* Male Female Non-Binary OtherRace / Ethnicity of Program Participants* White / Caucasian Black or African American Asian / Pacific Islander Hispanic / Latinx Native American OtherIncome Level of Program Participants* Below Federal Poverty Level ALICE Above ALICE ThresholdHow does your program increase diversity and inclusion? Reduce inequities?*Describe the demographic composition of your board and staff. List any trainings that have been provided to them.*Your organizations equity statement (if available)Program Budget RevenuePlease list program revenue, both secured and pending. List Source if applicable, or N/A.United Way of Bay County Allocation*Secured Funds ($)Pending Funds ($)Source Other United Way Allocations (itemize per Local United Way)*Secured Funds ($)Pending Funds ($)Source Program Service Fees (if no fees please input N/A)*Secured Funds ($)Pending Funds ($)Source Individual Contributions / Fundraising*Secured Funds ($)Pending Funds ($)Source Foundation Grants (Itemize and list individually)*Secured Funds ($)Pending Funds ($)Source Government Grants (State, Federal, County or City)*Secured Funds ($)Pending Funds ($)Source Invested Income (designated to this program)*Secured Funds ($)Pending Funds ($)Source In-Kind Donations*Secured Funds ($)Pending Funds ($)Source MiscellaneousSecured Funds ($)Pending Funds ($)Source Total Program Secured Revenue ($)*Program Budget ExpensesPlease list expenses you have budgeted, and plan to budget for this program.Salaries & Wages*2024 BudgetProjected 2025 Employee Benefits & Payroll Taxes*2024 BudgetProjected 2025 Specific Assistance to Individuals*2024 BudgetProjected 2025 Materials & Supplies*2024 BudgetProjected 2025 Occupancy Expenses*2024 BudgetProjected 2025 Insurance (if program required)2024 BudgetProjected 2025 Licensure (if program required)2024 BudgetProjected 2025 Other Expenses2024 BudgetProjected 2025 Please specify what other expenses include.Total Program Expenses ($)*Program Surplus / DeficitDoes this Program Budget have a Surplus or Deficit?SurplusDeficitN/APlease explain any surplus or deficit in the program budget.Impact InformationChoose which focus area your program aligns with and the corresponding output(s) and outcome(s) you will measure. Keep in mind that you will be held accountable to submit a report annually to measure progress within your program using these metrics.Education- Improve school readiness through access to affordable childcare and quality early education programs and initiatives.Health- Create awareness and increase access to resources and services for mental health and suicide, substance use disorders as well as domestic violence and child abuse.Income Stability- Equip individuals and families with the resources needed to achieve financial stability and have the opportunity to improve their socioeconomic status.Focus Area* Education Health Income StabilityOutputs* # of children participating in quality childcare and/or preschool programs # of parents/ caregivers receiving parenting education # of students participating in out of school time programming and/or supportsOutcomes* % of children who show progress toward or achieve developmental milestones % of parents/ caregivers who increase knowledge of children's development % of students who increase their reading or math levelOutputs* # of people provided access to mental health and SUD resources and services # of people provided shelter or safety # of people participating in preventive health programming or servicesOutcomes* % of people who gain knowledge of protective health behaviors % of people who successfully complete or maintain participation in programming % of people who show improvement of mental health/ quality of life statusOutputs* # or people participating in job skills training or financial education # of people provided with basic needs # of people served to overcome barriersOutcomes* % of people who gain employment % of people who increase their socio-economic status % of people who increase skillsPlease explain your data collection methods including tools and frequency.*ATTACHMENTSHidden501 (c)(3) determination letter or proof of tax exempt status*Max. file size: 128 MB.501 (c)(3) determination letter or proof of tax exempt status* Drop files here or Select filesMax. file size: 128 MB, Max. files: 1.HiddenIRS form 990 or 990 EZ*Max. file size: 128 MB.IRS form 990 or 990 EZ* Drop files here or Select filesMax. file size: 128 MB, Max. files: 1.HiddenAudited financial statement*Max. file size: 128 MB.Audited financial statement* Drop files here or Select filesMax. file size: 128 MB, Max. files: 1.HiddenNon Discrimination Policy*Max. file size: 128 MB.Non Discrimination Policy* Drop files here or Select filesMax. file size: 128 MB, Max. files: 1.HiddenCharitable Solicitation license (or letter of exemption)*Max. file size: 128 MB.Charitable Solicitation license (or letter of exemption)* Drop files here or Select filesMax. file size: 128 MB, Max. files: 1.HiddenRoster of current board members*Max. file size: 128 MB.Roster of current board members* Drop files here or Select filesMax. file size: 128 MB, Max. files: 1.HiddenAgency Logo*Max. file size: 128 MB.Agency Logo* Drop files here or Select filesMax. file size: 128 MB, Max. files: 1.Compliance with United Way of Bay County* I certify that our organization will comply with the adherence of standards set by the United Way of Bay County, including submitting reports on time, showcasing their partnership by attaching their logo on printed materials that are affiliated with this program, tagging and showing community partnership in social media posts that are affiliated with this program, displaying the "Community Partner" sticker at our organization, etc.Acknowledgement of Application Submission* I certify that I have reviewed my application in its entirety and that I have up uploaded all of the required documents to the best of my ability.Signature*Name First Last Date MM slash DD slash YYYY CAPTCHAIf you have any questions, please contact Michaela Garcia, Marketing, Communications & Events Manager, at (989) 893-7508 or [email protected].
