2009 Request for Funding Proposal

Application must be submitted before 11:59pm, August 31, 2008.

2009 Request for Funding Proposal On-line Submission

Dear Applicant,

Thank you for your interest in applying for 2009 River Valley United Way funding. It is very important that you review the following information carefully before beginning to work on your on-line submission. Your knowledge of this information could save you valuable time and effort. If at any time during this process you find yourself in need of assistance, please do not hesitate to call our office at 479-968-5089. Our office hours are Monday through Friday 8:00am to 5:00pm. If you are in need of more assistance than a short telephone conversation can provide, please feel free to call to schedule an appointment to come into our office and review the application. Appointments for application assistance will no longer be available after August 29, 2008 due to time constraints. It is therefore highly recommended that you begin the application process as soon as possible to insure you have adequate time to complete the process by the deadline.

The 2009 funding period is open to community groups whose services fit within some or all of the United Way Funding Priorities:

For an up to date listing of the Funding Priorities of the River Valley United Way, please

[click here].

Additionally, to receive 2009 funding, your organization must meet the following basic requirements:

Be designated as a 501(c)3 organization
Be in operation for two years or more
Submit to an audit performed by a Certified Public Accountant (click here for new audit requirement information)
Sign River Valley United Way's Memorandum of Agreement (MOA) - It is strongly recommended that you review the MOA document before moving forward in the application process. Each agency which receives funding from River Valley United Way must accept the terms of the MOA and return a statement signed by the agency director and President of the Board of Directors stating the agency's acceptance and agreement to comply with the MOA. The 2009 MOA can be reviewed by clicking [here]

Important information to avoid problems with on-line submission

Please print and review the application thoroughly BEFORE beginning the on-line submission
It is recommended that you print a copy of the application for each program for which you are applying. Complete the application off-line and enter your information at one session. Saving and returning to an application that has not been completed is not possible.
Multiple submissions are allowed though you must submit one application for each program for which you are applying.
Submissions in different Community Impact Areas are allowed. You must select one impact area for each program for which you are applying.

2009 Request for Funding Proposal

	AGENCY NAME:
	PROGRAM NAME:
	COMPLETED BY:
	TITLE:
	ADDRESS:
	CITY, STATE, ZIP:
	E-MAIL ADDRESS:
	TELEPHONE:

	Does your organization have 501(c)3 status?

	No	Yes		Federal ID #

Funding amount requested for calendar year 2009:
Estimated number of persons to be served:
Counties to be served by this program:

Please indicate ONE Community Impact Area in which your program addresses a health and human services need:
Education
Income
Health

This proposal was considered and approved on the day of , 2008 by the Board of Directors of this agency.

Signed: Title:
Signed: Title:

*Please initial to indicate that you have read each of the following statements:*
It should not be presumed that any applicant will be awarded a grant on an annual basis, nor should the availability of these grants be considered an annual part of an applicant's budget. Type initials here
No grants will be provided for sectarian religious purposes, non-human services, athletic teams, events, school activities to which school credit is earned, political activities, building and land improvements, or to fund prior year deficits. Type initials here
RIVER VALLEY UNITED WAY 2009 FUNDING APPLICATION FORM
Agency Name:
Program Name:
Agency Fiscal Cycle:
Amount Requested:

	PROGRAM BUDGET
	REVENUE	FISCAL 09 BUDGET	ACTUAL FISCAL 2008*	ACTUAL FISCAL 2007
	River Valley United Way
	Other United Ways
	Government Support
	Foundations/Private Grants**
	In-Kind Support
	Client/Program Service Fees
	Contributions***
	Other Revenue**
	TOTAL PROGRAM REVENUE

	Foundations/Private Grants:
	Contributors:
	Other Revenue:


	EXPENSES	FISCAL 08 BUDGET	ACTUAL FISCAL 2008*	ACTUAL FISCAL 2007
	Salaries
	Benefits/Taxes
	Professional Fees
	Supplies
	Assistance to Individuals
	Travel
	Telephone
	Occupancy
	Payment to Affiliates
	Major Property/Equipment Acquisition
	Conference/Training
	Other: Please Submit Detail below
	TOTAL PROGRAM EXPENSES

	Other Expenses Detail:


	*If fiscal year is not closed upon application, please project figures to end of fiscal year and indicate below that you have done so.
	**Provide sources below
	***Individual contributions may be categorized as one line item unless a single contributor is responsible for over 5% of total funding for the agency.
	FISCAL 2008 FIGURES ARE PROJECTIONS BASED UPON ACTUAL EXPENDITURES: (Indicate yes or no. If yes, include date at which projections begin)

	FROM YOUR LATEST IRS FORM 990, WHAT PERCENTAGE OF YOUR ORGANIZATION'S EXPENSES ARE ADMINISTRATIVE/FUNDRAISING COSTS?

	Does the agency anticipate any significant changes in its resources, program services or clients served for the upcoming year? Please provide explanation of any unusual increases or decreases in the program's revenues and expenses, including any external issues or trends that may affect the program.


	VOLUME & UNIT COST
	Total # of program units:
	Cost per unit:
	(Total program expenses/total # of program units)
	Last year's unit cost:
	A unit of service for this program is defined as:

	BALANCE SHEET
		(2007)	(2008)	Increase/Decrease
	CURRENT ASSETS
	CASH
	SHORT TERM INVESTMENTS
	ACCOUNTS RCVBL
	INVENTORIES
	PREPAYMENTS
	INTEREST RCVBL
	OTHER CURRENT ASSETS
	TOTAL CURRENT ASSETS

	RESTRICTED FUNDS	(2007)	(2008)	Increase/Decrease
	CASH
	OTHER
	TOTAL RESTRICTED FUNDS
	LAND, BUILDINGS & EQUIPMENT
	LESS: ACCUMULATED DEPRECIATION
	NET LAND, BUILDINGS & ASSETS
	OTHER ASSETS
	TOTAL ASSETS

	LIABILITIES AND FUND BALANCES
		(2007)	(2008)	Increase/Decrease
	ACCOUNTS PAYABLE
	NOTES PAYABLE
	CURRENT MATURATES - LONG TERM DEBT
	DEFERRED INCOME
	RESTRICTED FUND
	OTHER CURRENT LIABILITIES
	TOTAL CURRENT LIABILITIES
	FUND BALANCES
	TOTAL LIABILITIES AND FUND BALANCES

	PROPOSAL NARRATIVE

	A. ORGANIZATION CAPABILITY
	1. Please provide the mission statement and vision of your organization.


	2. Please provide an overview of your organization including areas of expertise, accomplishments and population served.

	3. Please list other community entities that collaborate with your organization.

B. AGENCY NEED STATEMENT

1. Describe population to be served including geographic location.


2. State the circumstances, issues and/or barriers, faced by the agency's targeted population that warrants the need for the agency's services. Please use data and statistical evidence (i.e. local data, waiting list, community surveys) to support your response.


3. Identify similar programs that are currently serving the needs for your targeted population and explain how your program differs from currently offered services.



C. PROGRAM DESCRIPTION

1. Please state the program name.

2. Please list program funding needs (including dollar amount), in order of priority.


3. Explain how program activities and services will be provided including location of services.


4. Please detail how proposed program and services to be provided (methodology) will reduce barrier described in PROGRAM NEED STATEMENT (B2). Please include reference to any studies or evidence that indicates proposed strategies are effective with target populations.



PROGRAM OUTCOMES

5. Community-wide impact: Please provide information about the cumulative "return on investment" realized for the community during the program year.



D. CLIENT OUTCOMES

Describe changes or benefits clients will receive as a result of this program. Please include your major desired outcomes for this program.

		(Indicators)			(Results)
Outcomes (specific statement of the desired change in the lives of a particular group)		Outcome Measurement (information that indicates how well the program id doing regarding an outcome)			Goals (Broad statement of desired condition of well being for particular group)







E. DEMOGRAPHIC INFORMATION

2008 Clients Served (Effective 2009 funding cycle, this information is required.)

Program Name	Total # of Unduplicated Clients		Gender	Race		Age
			Male: Female:	Black White Latino Other		0-12 13-20 21-40 41-64 65+

Family Income	Indicate (by Place of Residence) Number of Clients Served			Number of Volunteers		Total Volunteer Hours
$0-$11,999 $12K - $19,999 $20K - $34,999 $35K - $49,999 $50K - $74,999 $75,000+	Johnson County Pope County Yell County

DIVERSITY EFFORTS

Please describe efforts this program has made, or is making, to reach out to or increase access for the varied and diverse groups of people that reside in the River Valley. What has this program done to address needs of specific groups?


	THE FOLLOWING ITEMS MUST BE MAILED TO RIVER VALLEY UNITED WAY AFTER SUBMISSION OF ON-LINE APPLICATION: 1 copy of latest financial audit 1 copy of your 501(c)3 letter from the IRS 1 copy of the application cover page, signed by an officer of your board. Mail to: P.O. Box 636 - Russellville, AR 72801 You will receive a copy of the completed form by email for your review. Please review your submitted application immediately for errors and contact Kristy Owens as soon as possible if there are errors that must be corrected. Please note that each field must be complete or your submission will not be accepted.

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