2025 UNITED WAY TARGETED FUND APPLICATION

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I. ORGANIZATION INFORMATION

Organization Name

Mission/Vision Statement

Executive Director/C.E.O. Name

Program Contact (for submission), if different from above

Program Contact Title

Submission Contact email

Submission Contact phone number

Organization Address, City, State, Zip Code (for official correspondence)

Federal Employer Identification Number (XX-XXXXXXX)

Social media presence links, if applicable (for example: website, Facebook, Instagram, etc.)

Board Chair Name

II. TARGETED FUNDING IMPACT ALIGNMENT

1. Program Name

2. Program approach

How does the program align with United Way's Targeted goal to prevent or interrupt neighborhood violence using either an emergent approach or an innovative approach?

Emergent approach addresses an identified community need using a promising practice or adapted method that is in development or early stages of implementation.

Innovative approach addresses an identified community need using a new method, model or practice that is designed to advance service delivery for maximum impact to clients served.

Targeted Fund will have one Focus Area for this cycle. Details about the desired impacts for the proposed project are noted below:

IMPACT AREA: Community Stability and Crisis Response

FOCUS AREA: Safety and Violence Prevention

Programs will aim to address emergent or innovative approaches to:

Advance efforts that prevent or interrupt neighborhood level violence including activities that meaningfully address restoration from harm, offer alternative approaches to promote community level healing, aims to decrease the likelihood of future incidents of violence, foster healthy conflict resolution skills, offer healing circles following exposure to neighborhood level violence or offer supports to address the mental health of those traumatized as a result of community level violence.

3. Tell us about your community and your agency’s connection to the community served.

4. Describe the program and the need it meets in the community. Provide examples of how this need was determined. Please share detail on the specified population this program aims to support, what evidence you use to support how you design the program, including previous history of implementation and key collaborations to support implementation.

III. PROGRAM APPROACH

Based on the Targeted Fund approach you selected, describe components of the program that fit the appropriate approach. Feel free to include examples to support your description.

IV. IMPACT MEASUREMENT

How will the lives of those served be transformed or improved for the better as a result of your approach? Please provide details on how you will know the desired change has occurred (e.g. how will you measure the desired impact or make improvements based on the results measured).

* Please Note: Once selected, United Way staff will provide guidance to grantees regarding the selection of standard United Way outcomes to be used for impact reporting.

Optional Supplemental Document Upload

The two items below are not required. If submitted, either document will be used as additional context detailing the scope of the proposed program.

Program Logic Model (Optional)

Theory of Change (Optional)

V. FUNDING NARRATIVE

1. Agency's local operating budget amount.

2. Total existing program budget amount (for the program associated with this funding request)

3. Funding Requested (Minimum $10,000; Maximum: $75,000)

4. Please describe the major sources of funding for the requested program. Include detail that illustrates confirmed funding for the requested program and projected funding request that are outstanding to support the requested effort.

SUBMISSION REQUIREMENT CHECKLIST:

These items must be submitted or affirmed in order for your application to be considered for funding review. If missing, application does not meet minimum requirements for consideration.

1. Submit federal 501(c)(3) tax determination letter (including EIN as noted above)

2. Submit Missouri or Illinois certificate of corporate good standing

3. Submit policy on compliance with USA Patriot Act and other counterterrorism laws.

4. Affirm your organization has a written policy for background checks, including child abuse and neglect screenings, if applicable.

I affirm my organization has a written policy for background checks, including child abuse and neglect screenings.My organization does not have a written policy for background checks, including child abuse and neglect screenings.

5. Affirm your organization has a written policy on privacy prevention practices (HIPAA).

My organization has a written policy on privacy protection practices (HIPAA)My organization does not have a written policy on privacy protection practices (HIPAA)

6. Affirm your organization has a written policy on non-discrimination in hiring and service delivery.

I affirm my organization has a written policy on non-discrimination in hiring and service delivery.My organization does not have a written policy on non-discrimination in hiring and service delivery.

Most Recent Audited Financials:

Organizations with operating budgets of $250,000 or more are expected to have audits performed by a certified public accountant (CPA). Please note if the required documentation is not submitted, your application will not be reviewed for funding consideration.

For audit submissions: submit the most recent audited financial statements, including the auditor's opinion, management, and/or internal control findings letter prepared by an independent auditor.

For organizations with budgets less than $250,000 without an audit: submit narrative justification detailing why the organization did not obtain an audit, the most recent 990 or 990EZ and a third-party financial compilation report.

a) For audit submissions: submit the most recent audited financial statements, including the auditor’s opinion, management, and/or internal control findings letter prepared by an independent auditor;

Additional File Upload

b) For organizations with budgets less than $250,000 without an audit: submit narrative justification detailing why the organization did not obtain an audit, the most recent 990 or 990EZ and a third-party financial compilation report.

Additional File Upload

Submission acknowledgement:

Please select an option related to the accuracy and completeness of this application.

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