`ROUTT COUNTY UNITED WAY
2015 GRANT APPLICATION OVERVIEW
Member Agency Application
MISSION
Routt County United Way inspires, leads and unites people, ideas and resources to advance community
impact in education, income stability and health. Routt County United Way is a recognized leader in
enabling our community to understand and meet its health and human service needs. We envision a
community where our children and adults succeed through education, income stability and healthy
lives.
APPLICATION CRITERIA
RCUW only accepts program-funding requests. For 2015, RCUW will have two main funding areas:
Core Funding (safety net and crisis intervention programs) and Community Impact Target Funding
Areas. Community Impact Target Funding Areas receiving emphasis for the next year are:
1.
2.
3.
4.
Affordable, High-quality Early Childhood Education and Child Care
At-Risk Youth
Economic Self-Sufficiency
Health deficits for low income (dental, adult ATOD, etc)
Any agency requesting program funding from Routt County United Way must provide services to
Routt County residents that fulfill a human service need. Those organizations receiving funding must
also meet the following criteria:
Member Agencies:
 Must have a current 501 (c)(3) determination of tax-exempt status from the IRS or be
affiliated or identified with a 501 (c)(3) organization that will receive and distribute funds as
directed by Routt County United Way.
 Must enter into a Member Agency Agreement with Routt County United Way
APPLICATION PROCEDURE
Please submit your signed application by email only to kate@routtcountyunitedway.org. Please submit in
3 PDF attachments in the following format:
1. Grant Body – attachment 1
2. Financials – attachment 2
3. Compliance – attachment 3
Application must be received by Monday, January 12, 2015 no later than 5:00pm.
Questions should be directed to Kate Nowak at 970-879-5605
Special Note for Childcare Agencies
Your applications are to be completed and sent to First Impressions, as they will be presented to the
Allocations Committee as a block grant. You must coordinate your application with First Impressions.
If you have any questions, please contact Stephanie Martin at 970-870-5270.
RCUW revised 11-30-2014
ROUTT COUNTY UNITED WAY
MEMBER AGENCY GRANT APPLICATION
Please format your grant application in the same order as below indicated by the same outline format
(indicating each section by letter/number/letter).
GRANT BODY: ATTACHMENT 1
A. GRANT APPLICATION SUMMARY: (use attached form)
B. NARRATIVE: (preferred length not to exceed four pages)
1. Agency Information (one page only)
a) Mission statement; brief statement of organization's goals and/or objectives
b) Brief summary of organization's history
c) Description of current programs, activities, and accomplishments
d) Number of staff and volunteers, including volunteer hours
e) Role of Board of Directors and percent that contribute financially.
f) Agency support of the United Way campaign
g) Any specific challenges your organization might be experiencing
2. Purpose of Grant - This section, number 2 through 4 (not to exceed two pages) should include
the following:
a) Brief statement of the issue to be addressed; description of constituency served
(include number served); target population; and how they will benefit
b) Description of goals and objectives of the program
c) Timetable for implementation if program is new
d) Other organizations, if any, collaborating with your organization
e) Other local requests that have been made for funding
3. Intended Outcomes – Please complete the attached Logic Model form, please use one form for
each outcome. In the narrative, describe the indicators you intend to measure, any benchmarks
to compare, targets you hope to achieve, and data collection methods you propose to use.
4. Evaluation - Please discuss how you define and measure success of the funded program.
5. Did you receive funding for any program in 2014? If so, complete this Reporting Outcome
Results below (not to exceed one page). If not, you can skip number 5.
Reporting Outcome Results
Please use the questions below to organize your results info.
a) Restate the program title and objectives
b) Were the stated 2014 program outcomes achieved?
c) How do you know (objective measurement criteria if possible)?
d) If outcomes were disappointing, what could be changed to improve outcomes in the
future
C. BOARD & FINANCIALS ATTACHMENTS 2:
1. Board of Directors
a) Occupations and/or community affiliations
2. Financial information
a) Most recent audit
b) Current year-to-date balance sheet and income statement
c) If the most recent audit is dated more than 12 months old from the due date of this
application, submit profit and loss statement and balance sheet for the most recently
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completed complete fiscal year with previous year comparison
d) Current agency budget
e) Copy of proposed program budget for the funding year (acceptable in draft form)
f) If organization is using a fiscal agent/sponsor, a copy of the memorandum of
understanding or contract between the organization and fiscal agent/sponsor
D. COMPLIANCE: ATTACHMENTS 3
1. A copy of the original IRS determination letter indicating 501(c)(3) tax-exempt status
2. Certificate of good standing with the State of Colorado with your Charitable Solicitation
number noted on the bottom of the certificate
3. Anti-discrimination statement adopted by board
RCUW revised 11-30-2014
ROUTT COUNTY UNITED WAY
2014 GRANT APPLICATION
A. GRANT APPLICATION SUMMARY
Organization Name:
Physical Address:
Mailing Address:
City, ST Postal:
Phone Number:
Email Address:
Contact Person:
Title:
Executive Director:
Organizational or Program Budget: $
Amount of Request: $
Fiscal Year Ends:
Brief Description of Request:
Signature, President, Board of Directors
Date
Signature, Executive Director
Date
RCUW revised 11-30-2014
INPUTS
ACTIVITIES
OUTPUTS
OUTCOMES
INITIAL
OUTCOMES
INTERMEDIATE
ROUTT COUNTY UNITED WAY
OUTCOME LOGIC MODEL
RCUW revised 11-30-2014