2023 New Applicant Short Form Application – United Way of Central Kentucky

2023 NEW APPLICANT SHORT FORM

APPLICATION

Part A – Grant Applicant Summary Sheet:

1. Agency Name:

2. EIN Number:

3. Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

4. Name of CEO or Executive Director:

Phone

Person(s) managing program(s) if not CEO/Executive Director:

Title

Phone

5. My program(s) services one or more of the following UWCK service areas (please check all that apply):

Breckinridge

Grayson

Hardin

LaRue

Meade

6. List the name of each program for which funding is requested and select the UWCK Focus Area with which services most closely align (limit one Focus per program):

Program 1 Name

Funding Requested

Focus Area

Education- School Readiness

Education- Supportive Relationships

Financial Stability

Health

Basic Needs

Program 2 Name

Funding Requested

Focus Area

Education- School Readiness

Education- Supportive Relationships

Financial Stability

Health

Basic Needs

Program 3 Name

Funding Requested

Focus Area

Education- School Readiness

Education- Supportive Relationships

Financial Stability

Health

Basic Needs

Program 4 Name

Funding Requested

Focus Area

Education- School Readiness

Education- Supportive Relationships

Financial Stability

Health

Basic Needs

Part B – Your Agency and Program(s):

1. Please describe your agency mission (50 words or less):

2. Describe in detail the program(s) for which the requested funds will be used and how it will address one of the United Way impact strategies as outlined on page 4 of the Application Guide. Please be specific about what the funds will be used for- ie. supplies, staff support, materials, etc. (No more than 400 words per program)

3. Describe the community problem that the program(s) will address. Include at least one current statistic (with citation) that most profoundly demonstrates the need for your program(s). If funding more than one program is sought, please respond as relates to each program. (No more than 300 words per program):

4. Describe the target population(s) this program serves. The target population identifies who will change as a result of the program’s intervention. Briefly explain how constituents enter and exit the program and describe your program’s constituents (age, gender, race, needs, risk factors, etc. as relevant), the conditions they face, and a general profile of their strengths and challenges. Describe the specific plan for reaching that population. (No more than 400 words per program):

5. How does the program help clients break cycles that keep them in poverty? (No more than 300 words per program):

Submission Instructions: Complete document by hitting submit button at the bottom of the form. Deadline is no later than 4:00 p.m. EST on March 7, 2023 . Late proposals will not be accepted.