2023 Putnam County Funding Application

Instructions

You are not required nor recommended to complete this application in one sitting. You may save your work, log out and sign back in to continue as many times as needed. Your login to this website is all that is required. Please save your work often! Web pages time-out, internet service is interrupted, and batteries die. This form times-out after 2 hours of non-use.

Copy and Paste is accepted and encouraged; rich-text formatting is not. Throughout the application, some short and long answer fields have a special feature in the bottom-right corner that allows you to expand the visible space. Simply click and drag to a new size.

Prior to submitting the application, gather the following:

2 years (2020 and 2021) 990 or 990EZ or 990 N
Either 2 years financial statements audited by a 3rd party or internal financial statements (2022 year-end and most recent 2023 internal financial documents: Profit and Loss statement & Balance Sheet). If neither are available, please complete this template (download file to edit).
Current and prior year's budget
Proof of insurance
501(c)3 Determination Letter

Important Dates

Application Opens: Monday, April 17, 2023
Application Deadline: Sunday, April 30, 2023 at 11:59pm
Award Announcements: May 19, 2023
Grant Contracts Due: June 13, 2023
Funds Released: Mid-June 2023
Mid-Year Report Qualitative Success Story Due (Clients served between 7/1/2023-12/31/2023): January 31, 2024
Year-End and Qualitative Success Story Report Due (Clients served between 7/1/2023-6/30/2024): July 31, 2024

Submission

The SUBMIT button is on the very last page of this application. You will have one last screen to review and at the bottom of that screen is the final opportunity to PRINT your application or to EDIT your application. Once you are confident that your application is complete and ready to be submitted, click CONFIRM. After clicking confirm, the application is no longer available to edit.

Questions from applicants will only be accepted by email to Chris.Flegal@uwci.org.

Funding Criteria

Grants will be awarded in the range of $10,000 (minimum) to $20,000 (maximum) for each community-based organization selected.
Funding commitments will be for one year with the funds distributed by mid-June 2023.
Must be a nonprofit headquartered in Putnam County, Indiana.
Funded organizations must be actively serving the ALICE population of Putnam County, Indiana (i.e. individuals/families that fall under 185% FPL)
Applicant proposals must align with current UWCI impact areas.
While reporting on specific outcomes will be required, funds will be unrestricted and may be used for general operating support.
UWCI’s grantmaking values will be used in application review and decision making. Speak to these values in your application.

Sections

The application is divided into eight sections. Each can be accessed by the navigation at the top of each page.

Section 1 - Executive Summary and Focus Areas

Section 2 - The Plan

Section 3 - The Process

Section 4 - Outcome Reporting and Population Demographics

Section 5 - Budget

Section 6 - Additional Organization Information

Section 7 - Staff Information

Section 8 - Attachments

Organization Name:

Street Address

City

State

Zip Code

Federal EIN #

What is your staff size?

Application Submitted by:

First Name	Last Name	Job Title
Email	Phone Number

Section 1 - Executive Summary and Focus Areas

Executive Summary
1. In the space below, provide a succinct overview of your application. Include information on how your application proposal aligns with your organizational mission and vision and with the UWCI impact area goals. Briefly touch on each section of the application. This summary should be in narrative format and consist of no more than 500 words.

Focus Areas

3. Will your organization address System-Level improvements in this application?

YesNo

3a. Describe the macro systems-level impact you expect to achieve as a result of this grant.

4. How does the organization address diversity, equity, and inclusion through its service design process? How does the organization incorporate the voice of recipients and community into the design and implementation of its services?

Section 2 - The Plan

1. Provide a detailed description of your program(s), the services your population will receive, and the role of your organization and any partners.

2. Explain why this work is impactful (include qualitative and quantitative evidence).

3. Are you seeking funding for a new program, expansion of a current program, or continuation of a current program?

4. How has your organization identified community needs through client feedback to inform your program(s)? Include any quantitative and qualitative data to document the identified needs.

5. Identify the barriers to successful execution and address how your organization will address these barriers?

6. Sustainability: How does the organization plan to sustain these activities beyond funding from United Way? Describe measures the organization has taken to ensure the services are available to meet your constituents' needs and efforts taken to leverage additional support (including in-kind). Comment on whether the organization is seeking funding to maintain existing, start new or expand services.

Section 3 - The Process

1. Provide plan of execution (process). Discuss where you are currently and how you plan to accomplish your proposal by the end of the funding year.

2. When will client programming and/or System-Level work begin?

3. In the table below, please list any significant partnerships (beyond referral partnerships) to implement your core innovative plan and provide the requested information for each partnership:

Partner or Organization Name

What services will this partner provide?

What goals will this partner help you achieve?

How long have you been engaged with this partner?

Do you have an MOU that details the working relationship?

YesNo

4. Identify the key activities to be executed if funding were awarded.

5. How will your organization ensure adequate staffing to successfully implement your proposal? Does your organization intend to add new staff or restructure current staffing? Include qualifications of key staff?

Section 4 - Outcome Reporting and Population Demographics

If other, please provide additional details.

2. How will you assess progress and determine effectiveness of your program(s) (include quantitative and qualitative measurements)?

3. How many unduplicated families do you plan to serve during this one-year grant period?

4. How many unduplicated individuals do you plan to serve during this one-year grant period?

Demographics

Provide demographics for all clients served last calendar year by your organization. Utilize “# of Unknown” for those served, but where this demographic was not captured.

Example: 300 clients last year. Intake forms recorded that 100 were Male, 100 were Female, 5 were gender diverse/gender non-conforming/transgender, 95 were unknown.

Demographics

To the best of your ability, please provide demographics for all clients served last calendar year by your organization. Utilize “# of Unknown” for those served, but where this demographic was not captured.

Example: 300 clients last year. Intake forms recorded that 100 were Male, 100 were Female, 5 were gender diverse/gender non-conforming/transgender, 95 were unknown.

5. Number of unduplicated families served last calendar year (if your proposal does not serve families enter 0).

6. Number of unduplicated individual clients served last calendar year.

7. Number of families turned away from services or placed on a waiting list because of limited capacity during the last calendar year.

8. Number of individual clients turned away from services or placed on a waiting list because of limited capacity during the last calendar year.

9. Describe the service boundaries for your services: counties, zip codes, neighborhoods, etc.

10. Number of clients served last calendar year by county:

Boone County	Hamilton County
Hancock County	Hendricks County
Marion County	Morgan County
Putnam County	# of Unknown

11. Number of clients served last calendar year by age category:

0-4	5	6-12	13-18
19-24	25-39	40-54	55-64
65-74	75-84	85+	# of Unknown

total # of children last calendar year

total # of adults last calendar year

12. Number of clients served last calendar year by gender:

Male

Female

Non-binary

Transgender Male (gender not aligned with the sex assigned at birth)

Transgender Female (gender not aligned with the sex assigned at birth)

# of Unknown

13. Number of clients served last calendar year by race:

African-American or Black	American Indian or Alaskan Native
Asian	White
Two or more races	Native Hawaiian or other Pacific Islander
Race (Other)	# of Unknown

14. Number of clients served last calendar year by ethnicity:

Hispanic or Latino

Non-Hispanic or Latino

# of Unknown

15. Number of clients served last calendar year by education level:

Not school-aged	Less than high school
High school/GED/HSE	Some college
Two-year degree	Four-year degree
Technical Degree	Master's degree
Doctorate degree	# of Unknown

16. Number of clients served last calendar year by employment status:

Employed full-time (35 hours or more per week)	Employed part-time (less than 35 hours per week)
Unemployed (seeking employment)	Not in workforce (homemaker, disabled, retired, student, children)
# of Unknown

17. Discuss specific limitations or barriers that prevent collecting data in the categories above and your organization’s plan to address those limitations.

18. Number of clients served last calendar year by income level:

At or Below Federal Poverty Level (FPL)*

Above Federal Poverty Level to 185% FPL

Between 186-250% FPL

Above 250% FPL

# of Unknown

* For a chart on Federal Poverty Guidelines, click here.

Section 5 - Budget

Use this section to reflect revenue and expenses for your program(s). This section’s intent is to understand what it takes to create and deliver services or systems-level impact. Grant funds will be unrestricted. However, estimated expenses required to support the proposed services will help the application review team determine levels of investments and resources needed from other sources. Although funding is unrestricted, please ensure your funding request is aligned with the cost to deliver your proposal.

(please use only numerical characters -- no dollar signs, no commas, or no decimals)

Budget

Income	Expenses
UWCI Request $	Direct Assistance $
Government Grants $	Direct Personnel (Employee Compensation) $
Philanthropic Grants $	Direct Operating Expenses $
Program Revenue $	Indirect Costs $
Other (1): $	Other (1): $
Other (2): $	Other (2): $
Other (3): $	Other (3): $
Total Income $	Total Expenses: $

Specify Other Income (Fundraising Events, Corporate Donations, Individual Donations, etc.):

Specify Other Expenses:

Definitions

Direct Assistance: The value of goods purchased and distributed to clients (bus passes, gas cards, etc.) or cash value of direct payments (rental or utility assistance).
Direct Operating Expenses: Facilities (rental and/or occupancy costs), Printing & Publications, Client Tracking System, Equipment, Supplies, Marketing & Advertising, Travel, Contracts, etc.
Indirect Costs: Fixed or variable costs not directly traced to the service delivery but attributed to this service based on a reasonable assumption by the community-based organization’s accountant or auditing firm.

Cost/client

1. Unduplicated individuals you plan to serve during this one-year grant period. (this is pulled from Section 4, Question 4)

Cost/client

$

2. If needed, you may add context to help us better understand your cost/client. If you believe this is sufficiently covered in your application, you can answer N/A.

3. Identify non-monetary resources needed to make your initiatives successful (e.g., volunteers, advocacy, and capital investment).

Net $

Request % of total Rev

Request % of total Exp

Section 8 - Attachments

2 years (2020 and 2021) 990 or 990EZ or 990 N

Do you have 2 years of financial statements audited by a 3rd party?

YesNo

Upload 2 years of financial statements audited by a 3rd party.

Do you have internal financial statements (2020 year end and most recent 2021 internal financial documents: Profit and Loss statement & Balance Sheet)?

YesNo

Upload internal financial statements (2022 year end and most recent 2023 internal financial documents: Profit and Loss statement & Balance Sheet).

Please complete and upload this template (download the file to edit).

Current and prior year's budget

Proof of insurance

501(c)3 Determination Letter

Please note: after clicking Submit, there is one more step.

After clicking the Submit button below, you will have one last screen to review the full application.
At the bottom of that screen is a final opportunity to print the application, go back and make an edit, or confirm.
After clicking Confirm, the application is no longer available to edit. An email confirmation will be sent to the email address listed on page 2.

Questions from applicants will only be accepted by email to Chris.Flegal@uwci.org.

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