Bullhead City/Laughlin & surrounding areas Kingman & surrounding areas Lake Havasu City & surrounding areas La Paz County Needles
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1 AGENCY ANNUAL PROGRAM APPLICATION More Info Label #1: Text More Info Label #2: Text More Info Label #3: Text More Info Label #4: Text ANNUAL PROGRAM APPLICATION Do not change the application status to "Final" until ALL section of your application have been completed to your satisfaction. After your application has been marked "Final" it is considered submitted to United Way. Thereafter, you will be able to view and print a complete copy of the form but it will not be possible to change any submitted information. APPLICATION STATUS Draft Application Year 2016 PART I--COMMUNITIES SERVING Choose only one community that this program is currently providing services in. COMMUNITY Bullhead City/Laughlin & surrounding areas Kingman & surrounding areas Lake Havasu City & surrounding areas La Paz County Needles PART II--AREA PROGRAM COORDINATOR List who the local area program coordinator is for this program so we may contact them for special events or referrals. Coordinator Name Coordinator Phone # Coordinator PART III--PROGRAM SUMMARY RCUW funds programs delivered by Agencies. The name of your program will be used in our Marketing Materials. Agency Name Program Name Select Only One Community Impact Area IMPACT AREA EDUCATION--Helping People Achieve Their Potential INCOME--Promoting Financial Stability and Independence HEALTH--Improving Peoples Health
2 Identify existing needs in the service area which will be addressed by this program. Discuss how the level of need has been determined. Discuss the impact that United Way funding will have on this program. If less than the requested amount is offered, discuss how it may affect the program. Discuss other sources of funding expected in support of this program (i.e., grants or contracts, fees charged for services, specific fundraising activities, etc.). AMOUNT REQUESTED THIS APPLICATION Total Request Estimate the % this request will cover from the annual budget revenue. PART IV--PROGRAM DETAIL
3 Does this program collaborate or "partner"--whether formally or informally--with any other service delivery organization in the community. If so, please discuss. Response No Yes Discussion By receiving funds from RCUW would it conflict with other funding sources you currently are receiving or applying for? Discussion PART V--PROGRAM BUDGET It is expected that the proposed Program Budget will reflect balanced revenues and expenditures. If budget is not balanced, fully explain the reasons for any deficits or surpluses in the narrative section. The following budget format is intended to closely follow the standard financial reporting guidelines of the U.S. Internal Revenue Service in its Form 990, common to most not-for-profit tax-exempt organizations. ESTIMATED PROGRAM REVENUES (Round to nearest whole dollar amount.) Proposed United Way Allocation All Other Revenue TOTAL REVENUE ESTIMATED PROGRAM EXPENSES (Round to nearest whole dollar amount.) Salaries, other compensation, employee benefits and taxes
4 Occupancy, rent, utilities & maintenance Printing, publications, postage and shipping Conferences, Conventions & Meetings Fundraising & Special Event Expense Other Expense (Describe in Narrative) TOTAL EXPENSE Narrative Comment This United Way may not contribute toward the support of any program expending more than 25% of its total support and revenue on management and general expenses, including fundraising expenses. In the spaces below, the projected percentage of administrative expense allocable to this program is calculate. Note that this calculation is based solely on administrative and fundraising expenses attributable to this specific program while a similar percentage reflecting the applicant organization's total administrative cost is calculated separately as a part of the Annual Agency Financial Accountability form. These fields should auto-calculate based upon budget figures entered above. If they do not auto-calculate, please use this formula (Professional Fundraising Fee + Fundraising Special Event Exp + Allocated Agency Admin) / Total Revenue * 100 = answer by percentage. PART VI--PROGRAM OUTPUTS AND OUTCOMES Combined Outputs Statement
5 Unit of Service Estimate for Annual delivery (#) Use 20 words or less to describe what you are tracking, ex: people, households, meals, items, etc. *To help with reporting purposes, indicate the number of unduplicated individuals that are anticipated to be served by this program. If you report households, the national average household is 2.62 people. This may or may not be same number in first box based on your description. PART VII--PROGRAM IMPACTS In order to help United Way effectively communicate the impact which this program has upon the community, please provide at least one example of an IMPACT STORY--a story which illustrates how the services of this program have positively impact the life of a specific client or household. Names may be changed in order to protect privacy at the request of the individual(s) involved. Provide a story from the most current year and not presented on a previous application. We have been using these stories in our monthly newsletters, if you have pictures to go with your narrative, please comment so with the story. Impact Story
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