2025 Systems Change Cycle Application

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ORGANIZATION INFORMATION

1. Organization Name

2. Mission/Vision Statement

3. Executive Director/C.E.O. Name

4. Program Contact (for submission), if different from above

5. Program Contact Title

6. Submission Contact email

7. Submission Contact phone number

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

9. Federal Employee Identification Number (EIN)

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

11. Board Chair Name

12. Who are the agency's top three key referral partners for client services and support?

13. Has the agency experienced any legal, ethical, safety, or regulatory issues within the past 14 months? If, yes, explain.

PROGRAM SECTION

1. Program Name

2. What specific counties within United Way's footprint will be served?

3. What is the Agency's main population for current family coaching and/or case management services?

4. Please describe the Agency's current assessment procedures and family coaching/case management services model.

5. How would the UFF program fit into the Agency's mission and strategic plan?

6. Does the Agency offer programs and services with a two-generation or whole family approach? If yes, please describe.

7. Does the Agency offer financial education, financial coaching, or financial counseling to current clients? If yes, please describe.

8. Does the Agency offer workforce development services to current clients (job search, resume writing, job placement and training, etc.)? If yes, please describe.

9. How would the agency recruit for United for Families?

10. Does the Agency provide direct cash assistance funding (i.e. rental assistance, mortgage assistance, utilities assistance, childcare assistance)? If yes, please describe.

ADMINISTRATION

1. What staff training opportunities does the Agency provide around assessment, case management, and/or motivational interviewing? Please describe, if applicable.

2. What staff and/or volunteer training opportunities does the Agency provide around financial literacy and/or financial coaching? Please describe, if applicable.

3. What staff and/or volunteer training does the Agency provide around workforce development? Please describe, if applicable.

4. Please describe the Agency's efforts in integrating diversity, equity, and inclusion within its intake, assessment, and case management process.

IMPACT MEASUREMENT

1. Total direct clients the Agency anticipates serving through this program from January 1, 2025 - December 31, 2025.

2. Please describe specific case management software(s) the Agency utilizes, if applicable (e.g. Salesforce, Apricot).

3. Describe the Agency's intended continuous quality improvement (CQI) for this program.

REQUEST BUDGET SECTION

1. How would funding for family empowerment coaching through the United for families program help you better serve families?

2. Demonstrate how the requested grant amount will be used as outlined in the budget template below. To complete the request budget, click the here You will need to download the spreadsheet and submit with your application as an attachment.

2. Request Budget Upload

3. Budget Explanation - please provide a narrative summary of the line items included in your proposed budget.

SUBMISSION REQUIREMENT CHECKLIST

These items must be submitted or affirmed in order for your application to be considered for funding review. United Way reserves the right to request any policy referenced bv the grantee for affirmation post award determination.

1. Submit Federal 501(c)(3) Tax Determination

2. Submit Missouri or Illinois Certificate of Corporate Good Standing

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

4. Submit policy for background checks, including child abuse and neglect screenings, if applicable.

5. Submit policy on non-discrimination in hiring and service delivery

6. Submit policy on privacy retention practices (HIPAA)

7. Does the Agency have a client grievance policy? If yes, please attach.

YesNo

Client Grievance policy upload

8. 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 auditors opinion, management, or internal control findings letter prepared by an independent auditor.

Organizations with budgets less than $250,000 may provide narrative justification for not obtaining an audit for funding consideration and in lieu will submit 1) narrative justification 2) the most recent 990 or 990 EZ and 3) a third-party financial compilation report.

For Budgets Greater than $250,000

Audit

Auditor's Opinion/ Management/ Internal Control Findings letter

For Budgets Less than $250,000

Narrative Justification

990 or 990 EZ

Third-Party Financial Compilation report.

I hereby certify that the information provided in this submission is accurate and complete.

YesNo

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