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Agency Application

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Agency Application

Agency Application

Agency Application

Today's Date

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)

Street Address

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

Official Title

Part II - Program Information

Agency Name

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.

Angoon

Craig

Haines

Hoonah

Juneau

Kake

Kasaan

Ketchikan

Klawock

Metlakatla

Petersburg

Sitka

Skagway

Wrangell

Yakutat

Other

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

No

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

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.

Upload 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.

Bylaws

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.

Organizational Chart

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.

Non Discrimination Policy

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.

Code of Ethics

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.

Fiscal Policies

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.

Strategic Plan or Business Plan (if available)

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.

Upload your most recent 501c3

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.

Most current Audited Financial Statements

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.

Most recent 990

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.

Board of Directors listing

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.

Any additional comments

Leave this field blank

We believe that everyone should have the opportunities for a good life.

Contact

8711 Teal Street, #204
Juneau, AK 99801

907.463.5533

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