Forms2 | United Way of Dickinson County

Please provide important contact information re: agency/nonprofit submitting grant:

The Application Deadline for 2023 has passed. Applications for 2024 will be posted in the Fall.

2023 Grant Application

Name of Person Submitting Grant(Required)

First Last

Agency / Nonprofit Name

Street Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address (If Different from Above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Website

Mission Statement

Primary Contact’s Full Name

First Last

Primary Contact’s Title

Primary Contact’s Phone Number

Primary Contact’s Email Address

Program Name

Amount Requested(Required)

Identify community impact area(s) this program addresses:

Provide Program Background: Year started, accomplishments

Who is the target audience / population?

List other current funding sources and additional revenue sources for this program:

Explain specifically how United Way funding will be used (include whether the funding will help add new services or supplement funding to maintain current service levels):

Current Annual Budget

Number of individuals not served in Dickinson County due to limited resources

Desired Outcomes

Indicators of Success

List positive outcomes already established as a result of this program:

List any influencing factors affecting the outcome results:

80815

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