Community Collaborative Grant Application 2015-2017
Through this funding opportunity, United Way will offer grant funding to projects that address at
least one United Way focus area, and the related indicators to be measured. For detailed
information on the focus areas (Education, Health and Financial Stability), and the related
indicators, refer to the 2015-2017 Community Impact Grant Guidelines.
Resources to aid you in completing the grant application: The following documents can be
downloaded here, or you can download them from United Way's website.
DOCUMENTS AND FORMS
1. 2015-2017 Community Impact Grant Guidelines (PDF)
2. Budget Form
3. Logic Model - Outcome Measurement Plan and Performance Tracker Form
4. Logic Model Guide
5. Sample Memorandum of Agreements: Sample 1, Sample 2, Sample 3, Sample 4,
Sample 5
6. Collaborative Application Signature Page
7. Anti-Terrorism Compliance Form
OTHER RESOURCES TO HELP WITH YOUR PROPOSAL
1.
2.
3.
4.
5.
6.
Community Impact Fund Distribution Manual (PDF)
Collective Impact: The Five Conditions of Collective Impact
Understanding the Value of Backbone Organizations
Aligning Collective Impact Initiatives
Catalytic Philanthropy
Channeling Change: Making Collective Impact Work
CI Community Collaborative Grant Application 2015-2017 Grant Cycle
Due date: March 6, 2015 by 4:30pm
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Submission Instructions
NOTE: Proposals that are incomplete do not follow the formatting
requirements, exceed the page limit, or that request a funding amount
outside the grant range will not be considered.
Proposals must be submitted online or delivered in person no later
than Friday, March 6, 2015 by 4:30pm.
If you are submitting a hard copy application, the completed application
and attachments must be hand delivered to United Way no later than
4:30pm on March 6, 2015
United Way's business hours are Monday - Thursday, 8:00am - 5:00pm; and 8:00am 4:30pm on Friday.
You will be asked to attach documents during this application process. All documents
must be PDFs. You can download required documents from this application, or you can
download them from United Way's website. http://unitedwaymwv.org/our-work/20152017-grant-applications-forms-and-resources/.
1. Project Budget
2. Logic Model - Outcome Measurement Plan and Performance Tracker Form
3. Proof of the Fiscal Agency/Backbone Organization's Nonprofit Status (IRS
501(c)(3) determination letter).
4. The Fiscal Agency/Backbone Organization's most recent audited financial
statement, or the Profit & Loss Statement for the last two fiscal years.
5. Board Rosters for each organization that will sign the Memorandum of
Agreement. If an organization is not governed by a board (i.e. a government
agency) provide a list of key management staff.
6. Your collaborative’s fully signed Memorandum of Agreement.
7. Anti-Terrorism Compliance Form
8. Collaborative Application Signature Page
Proposals that arrived at United Way after the due date and time will not be
considered. If you have any questions contact Arturo Vargas, Community Engagement
& Impact Director, avargas@unitedwamwv.org.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Step 1: Review the 2015-2017 Community Impact Grant Guidelines
Keep same format, using Ariel 11-point font. Before you begin completing the
application, please read the Community Impact Collaborative grant requirements in the
2015-2017 Community Impact Guidelines. Follow this link:
http://unitedwaymwv.org/pdf/CI2015_17GrantGuidelines.pdf.
About the Fiscal Agent/Backbone Organization
Fiscal Agency/Backbone
Organization
Address:
Agency Director name:
Director's Phone Number
Director's Email:
Website:
Amount Of Funding
Requested:
$
Up to 80,000.00 per two years grant cycle.
Oregon EIN # (Fed. Tax
I.D. #)
Number of Clients Project
Will Serve:
County served:
☐Marion
☐Polk
☐Yamhill
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Briefly State the Overall Vision, Goals and Objectives of the Fiscal Agency/Backbone
Organization:
Organization's Website: Click here to enter text.
Does Your Organization have a Foundation (Yes / No)? Click here to enter text.
Year Fiscal Agency was founded?Click here to enter text.
Organization's Fiscal Year: Jan 1 - Dec 31 or July 1 - Jun 30, Other. Click here to enter text.
Collaborative Project Description and Information
Project Name: Click here to enter text.
Project Contact (if other than Director): Click here to enter text.
Project Contact Email (if other than Director):Click here to enter text.
County Served by Project (Marion, Polk, Yamhill) Click here to enter text.
Dollar Amount of requested for the project (two-year amount):Click here to enter text.
Is this a new or existing project? Click here to enter text.
If an existing project, how long has it been underway?Click here to enter text.
Has this project previously received United Way funding (yes / No)?Click here to enter text.
If so, when?Click here to enter text.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Focus Area This Project Will Address
Collaborative Program Grant applicants must select at least one United Way focus area
and the related indicators to be measured. Priorities and indicators within the focus
areas are well defined in the 2015-2017 Community Impact Grant Guidelines. United Way
will use the indicators to assess the outcomes and success of the collaborative.
Please select one Focus Area and one or more of the priority areas within the Focus Area
that best represent the collaborative outcomes for which you are applying for funding.
You may only choose one Focus Area, but you may select as many priority areas as
listed. You also have the option to add your own priority. Read the 2015-2017
Community Impact Grant Guidelines, document found here.
Focus Area
☐EDUCATION: To help children, youth and families achieve their
educational potential, from Cradle to Career.
Priority areas are, but not limited to:
☐Kindergarten readiness, age 0 to 5
☐Reading at grade level K-3
☐Successful transitions: Elementary-Middle-High school
☐High School Graduation
☐Other: Click here to enter text.
Focus Area
FINANCIAL STABILITY: To promote financial stability, independence and
new skill development for families, individuals and youth.
Priority on programs, services and systems that provide:
☐Financial literacy to promote self-sufficiency
☐Job skills development: vocational training and apprenticeship
☐FOR YOUTH-FOCUSED PROGRAMS: number of eligible youth (age
22 or below) that matriculated in an educational program such as GED,
Higher Education Program (HEP) and passed.
☐Other: Click here to enter text.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Focus Area
HEALTH: To improve people’s health and access to health care preventive
services and reduce people in engaging in risky behaviors.
With a focus on programs, services and systems on:
☐Obesity: preventative factors, healthy eating, physical activities
☐Mental Health Services, self-sufficiency programs
☐Addictions/tobacco cessation: promoting preventative factors
☐Services for mothers with infants and children
☐Other: Click here to enter text.
Collaborative Partners
List the Collaborative Partners (in addition to the Fiscal Agency/Backbone Organization)
who will sign the Memorandum of Agreement. Remember, in order to be considered, a
collaborative project must have at least three partners (including the Fiscal
Agency/Backbone Organization). If you have more than three collaborative partners, you
will be prompted to upload a separate list at the end of this section.
First Organization's Name:Click here to enter text.
Role & Responsibilities:
Key Contact Person:Click here to enter text.
Contact Person's Phone Number:Click here to enter text.
Email:Click here to enter text.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Second Organization's Name:Click here to enter text.
Role & Responsibilities:
Key Contact Person:Click here to enter text.
Contact Person's Phone Number:Click here to enter text.
Email:Click here to enter text.
Third Organization's Name:Click here to enter text.
Role & Responsibilities:
Key Contact Person:Click here to enter text.
Contact Person's Phone Number:Click here to enter text.
Email:Click here to enter text.
If you have more than three collaborative partners, attach your list to your email when
submitting application.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Narrative Section
Answers should not exceed 2000 characters per question, not counting spaces.
1. To whom you will be directing the services and why. This section should define the
community you will serve – include demographics and boundaries (county, city or
neighborhoods) you will serve.
2. What is the Collaborative's Common Agenda? – What is the common understanding of
the problem? Share the collective vision and approach the collaborative is taking to solve the
problem. Make sure to include a brief overview of how partners will relate and work interactively.
If you are serving more than one community, please explain how you will engage partners in
each geographic area you plan to serve? Your answer should align with the focus area,
priorities, and indicators you are selecting.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
3. Shared Measurement: Indicators – Based on the indicators identified in United Way's 20152017 Community Impact Grant Guidelines, please provide evidence that confirms a particular
condition exists in your region. Use local data to demonstrate there is a need in your region. List
specific data sources. Share any other indicators that you find relevant.
4. What is your Collaborative Communication Plan? – Describe the methodology that has
been agreed upon to ensure consistent and open communication among the agencies in the
collaborative. Make sure to give a description on how the communication plan will create trust,
mutual collaboration, shared outcomes, and build capacity to improve the outcomes for the
project. How often you will be meeting, and how will United Way of the Mid-Willamette will be
included? How do you plan to share your outcomes with the general public?
5. Specific Roles and Responsibilities of the Fiscal Agency/Backbone Organization –
Describe the type of support, and functions to the overall collaborative effort.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
6. What are the Mutually Reinforcing Activities – What are the mutually reinforcing activities
of the collaborative project that will be funded through United Way's Collaborative Grant?
Describe both individual and systemic activities.
7. Overview of Inputs – Inputs are the resources necessary to achieve the desired outcomes.
This includes assets present in the community, including resources that you may not have
considered in the past. In addition to the resources United Way and your collaborative partners
will provide, please identify additional programs, services, and assets that will help you achieve
your desired outcomes. This could include paid staff or staff provided to the collaborative as an
in-kind service, volunteers, facilities, equipment, etc.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
8. Project Inputs/Outputs – Provide an overview of the inputs, outputs, activities, and services
that will be funded through United Way's Collaborative Grant. Include numbers to be served.
9. Outcomes of the Mutually Reinforcing Activities: Individual Outcomes The specific
measurable results of the above strategy (inputs, outputs, services, and activities) that show
change in the original conditions for individuals.
**(Individual outcomes are the measurable changes expected for the individual participants of
the project (individual knowledge, skills, resources, behaviors and/or conditions as a result of
participating).
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Community Collaborative Grant Application 2015-2017 Revised February 2015
10. Outcomes of the Mutually Reinforcing Activities: Systemic Outcomes The specific
measurable results of the above strategy (inputs, outputs, services, and activities) that show
change in the original conditions for at least one system.
**(Systemic changes are the desired modifications and responses in systems, organizations,
neighborhoods and communities that the project will affect to better serve individuals and
families).
11. In addition to United Way funding, what other revenue sources will you use to fund
this project? Explain how each collaborative partner is contributing revenue resources.
List specific sources, amounts, and whether they are pending or committed.
12. How will the collaborative project be affected if the total grant amount requested is
not received?
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Community Collaborative Grant Application 2015-2017 Revised February 2015
13. Please describe how this project proposed in this application will be sustained
beyond the duration of this grant.
Outcome Measurement - Logic Model
Attach your Outcome Measurement Plan and Performance Tracker Form with the
application. You must use the form provided by United Way. You can download the
Outcome Measurement Plan and Performance Tracker Form found here.
**This form is intended as an outline that can be adapted to word processing by using the
column’s heading as a guide for narrative. All the items must be included and in the same order,
but you can allow adequate space as needed for the individual sections.
Project Budget and Budget Related Information
Attach the two-year project budget with your application. Your budget must use the
Budget Worksheet provided by United Way. Be sure to include amounts anticipated from
United Way, funding from partner organizations, in-kind resources, and other funding
leveraged from United Way grant funding.
Attach Your Program Budget Proposal with the application. You can download the
Budget Form found here.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Other supporting documents to attach to your application:
☐Attach the Fiscal Agency/Backbone Organization's most recent audited financial
statement or year-end reviews with your application.
☐Attach the Fiscal Agency/Backbone Organization's IRS 501(c)(3) determination
letter with your application.
☐Attach the Board Roster for each collaborative partner with your application. If
an organization is not governed by a board (i.e. a government agency) provide a
list of key management staff.
Formalizing Your Collaborative Partnership with a Memorandum of
Agreement
The United Way of the Mid-Willamette Valley values the ability and willingness of our community
partners to work with other organizations in order to achieve positive measurable results.
Strategies are typically enhanced when government agencies, nonprofit organizations, health
systems, business, leadership organizations and key individuals work together to bring about
lasting change in the populations or geographical areas of the community being served.
The United Way defines collaboration as a structured, mutually beneficial relationship between
two or more organizations (of any type, including key individuals) that work toward a common
measurable outcome by sharing resources, responsibility, authority and accountability for
achieving results.
It is more than agencies cooperating, responding to requests or referring clients. Collaborations
demonstrate a jointly developed structure and process for sharing information, decision-making,
budgeting, monitoring and evaluating effectiveness of the joint project. Effective collaborations
also include partners who may not have been funded by the United Way such as schools,
businesses, government agencies, individuals, etc.
All proposals are required to demonstrate a formal collaborative partnership representing three
or more organizations. A Memorandum of Agreement (MOA) must be signed by ALL
collaborative partners and included with each proposal. The MOA outlines the roles,
responsibilities and resources that each collaborative partner will bring to the project
collaboration. Partners must sign off on the community conditions assessed and the measurable
outcomes desired.
Attach your fully signed, by each of the partners, Memorandum of Agreement with your
application.
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Community Collaborative Grant Application 2015-2017 Revised February 2015
Certification
Download, sign, save and attach the signed Collaborative Grant Signature Page. This should be
signed by the Executive Director of the Fiscal Agency/Backbone Organization, and certifies that
they have read and understand United Way of the Mid-Willamette Valley’s funding guidelines
and policies, and that all statements and attachments included with this application are correct.
It also affirms that the Board of Directors has approved and signed off on the submission of this
grant.
Collaborative Grant Application Signature Page found here.
Attach the signed Anti-Terrorism Compliance Form found here
Save your grant application and mandatory attachments in your computer, convert to
PDF format an email it to intern@unitedwaymwv.org. Or bring your completed packet to
United Way offices by 4:30pm on March 6, 2015.
United Way of the Mid-Willamette Valley is located at 455 Bliler Avenue NE. Salem, OR
97301. For questions or technical consultation email Arturo Vargas, Community
Engagement & Impact Director, at avargas@unitedwaymwv.org
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Community Collaborative Grant Application 2015-2017 Revised February 2015