United Way of Lake and Sumter Counties
2016 Program Proposal Application
United Way of United Way of Lake and Sumter Counties
2016 Program Funding Proposal
Organization Name
Please submit Program Funding Proposal in the following sequence:
_______ 1. A Copy of this List
_______ 2. Cover Letter
_______ 3. Proposal Application (Word Document)
_______ 4. Program Budget (Excel Document)
_______ 5. Attachments:
 IRS 501(c)(3) designation letter
 IRS Form 990 or IRS Form 990 EZ (most recent)
 Financial audit (most recent)
 Management letter accompanying financial audit
 Agency budget (previous and current year)
 Agency by-laws
 Nondiscrimination and Equal Employment Opportunity (EEO) policies
 Insurance coverage certificate(s)
 Any required licenses and certificates
 Organizational chart
 Board of Directors Roster (include officers, term of service, employment and community
affiliations)
 Annual report (most recent)
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United Way of United Way of Lake and Sumter Counties
2016 Program Funding Proposal
Agency Overview
Agency:
Address:
City, State, Zip:
Telephone:
Agency CEO:
Email:
Proposal Contact:
Email:
Program Name:
25-Word Organization Description:
25-Word Program Description:
Is this a new funding request—i.e., is this program NOT currently funded by United Way in 2015?
 Yes 
No
Program Narrative
Please check the Community Impact Priority Area that your program is working towards and list the UWLS Strategy that aligns
with your program. Please refer to Page 11 of the 2016 United Way RFP.
______ Education
______ Health
______ Income
UWLS Goal and Strategy(ies) your program aligns with:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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1. PROGRAM DESCRIPTION – Describe, in detail, all program services and activities in which program participants
are engaged. If the program includes multiple program components, describe each component separately and label
the description of each component with a separate heading using CAPTIAL LETTERS. (Word limit: 1,000)
2. PROGRAM DURATION – Describe, specifically, the length of time a typical participant is engaged in the program and
the frequency of contacts and/or intensity of services during the time they are involved. What is the optimal length of time
and level of involvement in order for a participant to achieve the desired outcomes? If it varies depending on the
participant, or if it varies for different groups of participants, please explain. (Word limit: 500)
3. FUNDING REQUESTED
a) Operating Budget:
b) Project Budget:
c) Amount Requested:
4.
RATIONALE FOR FUNDING INCREASE - If requesting a funding increase explain your rationale. For
example, if the funding will increase the capacity of the program or replace a lost source of funding, please
describe. If this is first-time funding enter N/A. (Word limit 450)
5. PROGRAM LOCATION – Describe the location in which the program is delivered, including the address(es)
of the facility if the program is site-specific. (Word limit: 100)
6. TARGET POPULATION – Define the target population, including the size and circumstances of the population by
which program participants are identified. Include relevant descriptions of the demographics of program participants
(which may include age, gender, race/ethnicity, income level, geographic location, etc.). Address the risk factors and
community conditions affecting the target population that underlie the need for the program and any other relevant
characteristics of the target population. (Word limit: 450)
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Program Outcomes
1.
PROBLEM STATEMENT:
2.
COMPLETE PROGRAM LOGIC MODEL:
Program
Components
What is the goal?
(Minimum 3)
Example:
1) Provide
tutoring to
academically
struggling
high school
students as
part of an
after school
program
curriculum.
2) 75% of
participating
students
receive
improved
grades in
school.
3) 75% of
participating
students will
show
increased
attendance in
school and
tutoring
sessions.
Outputs
Number served
per
component?
What will you
do?
Benchmarks
Example:
By 6/1/2015
(mid-year):
35 high school
aged youth
will have
attended
regular
tutoring
sessions
(3x/week)
By 2/1/2015
(end year):
100 high
school aged
youth will
have attended
regular
tutoring
sessions
(3x/week)
Indicators/Measurement
Tools
How will you track and
measure your efforts?
Example:
 Attendance records
 Pre, mid and posttests
 Report cards from
teacher
Outcomes
Anticipated
Community
Outcomes
Number and
percent per
component
What will the
impact/result be?
Per component, big
picture; why is your
program
meaningful?
Benchmarks
Example:
By 6/1/2015
(mid-year):
Of the 35 youth,
75% (26 youth)
will have shown
at least one
grade level
improvement in
test grades over
a four month
period.
Example:
Youth will have a
higher record of
academic
achievement and
more youth will
graduate from
high school.
By 12/30/2015
(end year):
Of the 100
youth, 75% (75
youth) will have
shown at least
one grade level
improvement in
test grades over
a four month
period.
Please DO NOT
include this example
in your application.
1:
2:
3:
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Program Budget Narrative
1) Respond to the following questions related to the program budget.
a. If this proposal is a joint request by multiple organizations and the allocation will be divided among
them, indicate the percentage of the allocation that will be utilized by each partnering organization.
(Word limit: 50)
b. Are there any elements of this budget that need additional explanation? If so, please explain. (Word
limit: 100)
c. Describe how your program will sustain without United Way funds, and/or how it will continue to
operate in subsequent years once United Way funds are spent. (Word limit: 200)
2) Complete the Program Budget. Download form here: http://uwls.org/our-work/grants/.
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