2025 LIVE UNITED Grant Application | United Way of the Eastern Panhandle

Agency Name

Street Address

City

State

Zip Code

Mailing Address (if different)

Agency Phone Number

Agency Fax Number

Agency Website Address

Number of Employees

Agency Mission Statement

Program Name

Program Summary

Please describe who will be served by the proposed program.

Goals

Amount Requested (cannot exceed $5000)

Impact Area:

Primary Contact's First Name

Primary Contact's Last Name

Primary Contact's Email Address

CEO's First Name

CEO's Last Name

CEO's Title

CEO's Email Address

Current Annual Budget

United Way Request as a % of Total Budget

Please describe how your organization will use the requested grant funds.

Provide the number of unduplicated individuals served by this program in Berkeley County.

Provide the number of unduplicated individuals served by this program in Jefferson County.

Provide the number of unduplicated individuals served by this program in Morgan County.

What else would you like us to know about your program?

Desired Outcomes

Did your organization receive funds from UWEP in 2024-2025?

Does your organization have a profile on VolunteerEP.org?

Has your organization participated in the Quarterly Partner Agency Meetings this year?

Has your organization supported the United Way community campaign this year?

If yes, mark all that apply:

Other

Did your organization participate in the Unity Campaign?

Did your organization participate in Day of Caring?

Please attach a copy of your Program Budget.

One file only.
200 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Please attach a copy of your most recent 990.

Please upload a copy of your 501(c)(3) Tax Exemption Letter from the IRS.

Does your agency have a Whistle Blower policy? If no and approved for funding, you will be asked to create one. A sample is available.

If yes, include statement below:

Does your agency have a Conflict of Interest policy? If no and approved for funding, you will be asked to create one. A sample is available.

If yes, please describe:

What challenges and barriers does your organization face to address disparities in your funded program? What resources would be helpful in this effort?

Briefly describe any significant changes to your organization’s sources of revenue during the last 12 months. Specify if any federal and/or state funding to your organization has increased or decreased.

Briefly describe any additional information relative to the costs of your program or an increased demand for services.

Would you be interested in learning more about nonprofit sustainability and capacity building?

I hereby certify and affirm that all statements and documents enclosed in this application are accurate.

Name

Title