Agency Application | United Way of Southeast Alaska

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PART I - Agency Information

Organization Information

Name of person completing application

What is your affiliation to the organization for which you are applyling?

Agency's Name

DBA Name (if applicable)

City

State

Zip Code

Mailing Address (if different)

Agency's Phone Number

Agency's Fax Number

Agency's website address

Number of Employees

Agency Mission Statement

Primary Contact's Information

Primary Contact's First Name

Primary Contact's Last Name

Primary Contact's Email Address

Executive Director's Information

ED First Name

ED Last Name

ED Email Address

Part II - Program Information

What community impact area does the agency address?

Please list the programs, objectives, services provided, annual events, etc. of your agency.

Check all SE Communities in which your organization provides services and/ or has a physical location.

Please list the community name(s).

What is your target population?

Current Annual Budget

How do you use funding raised through United Way of Southeast Alaska

Estimated number of individuals not served due to limited resources

What else would you like us to know about your program

Part III - Qualifying Statements

Are you willing to promote UWSE activities, such as Annual Campaign, Day of Caring, Etc?

Yes

United Way does not fund organizations whose primary focus is advocacy. Do you primarily operate to deliver needed services to the community and operate lawfully with respect to limits on lobby activities?

We are NOT primarily an advocacy organization.

We ARE primarily an advocacy organization and thus do not qualify to receive United Way funds.

What was the date of your last renewal with the State Department of Law as a Charitable Organization?

What dates does your organizations Fiscal Year run?

Part IV - Documentation

Articles of Incorporation

Upload requirements

Upload your Program Budget

Upload requirements

Bylaws

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Organizational Chart

Upload requirements

Non Discrimination Policy

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Code of Ethics

Upload requirements

Fiscal Policies

Upload requirements

Strategic Plan or Business Plan (if available)

Upload requirements

Upload your most recent 501c3

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Most current Audited Financial Statements

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Most recent 990

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Board of Directors listing

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Any additional comments

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