FUNDING APPLICATION 2017


FUNDING APPLICATION 2017

FUNDING APPLICATION 2015

IMPORTANT: Before you start this application, please refer to the ‘Funding Application Guide’ to ensure your agency is eligible for funding.

The ‘Funding Application Guide’ provides step-by-step instructions detailing the answers you’ll need to provide for each question - complete with examples. Please use the guide as you progress through the application to ensure you are providing all required information.

If you are submitting more than one application or have submitted applications in the past, you are still required to answer all questions regarding your Agency as each application stands independently when reviewed by our Community Investment Committee.

While you prepare your application, please ensure you:

  • Are concise with your answers
  • Avoid acronyms and use of language specific to your agency
  • Provide only the information and attachments requested unless absolutely necessary
  • Complete the ‘Final Checklist’ on the last page of this application

DEADLINE: 4:30PM Wednesday, March 15th, 2017

Applications will only be accepted via email in Word or PDF Formats

Email:
Section A: AgencyDetails

Please provide answers to the following questions regarding your Agency.

  1. Official Name of Agency:
  1. Registered Charity Information
  1. What is your Canada Revenue Agency Charitable Registration Number?
  1. When did you last file your year-end information with the Canada Revenue Agency?
  1. Mailing Address:
  1. Location(s), if different than mailing address:
  1. Telephone Number(s):
  1. General Email Address:
  1. Website (URL):
  1. Social Media Accounts (URLs):
  1. Who should be contacted for more information about this application?

Name:

Title:

Phone Number:

Email Address:

  1. Incorporation Information
  1. Is your company registered under the Newfoundland and Labrador Corporations Act, RSNL1990, CHAPTER C-36?
  1. Ifyes, what is the corporation number? If no, please move to question 11.
  1. When did you file your last Annual Return?
  1. When is your Fiscal Year End?
  1. When were your last audited financial statements produced?
  1. When was your Agency formed?

14.Is the Agency a chapter or branch of a national body?

15.How many employees does your Agency have?

16.How many volunteers does your Agency have?

17a.Are there currently any outstanding legal claims against your Agency?

17b.If you responded “Yes” to Question 17a, please give details

18. Please include the following documents with you application:

  • Current Board of Directors Listing
  • Latest Annual Report or Board Report

Section B: Program/Service Details

1.What is the Agency’s Purpose/Mission Statement?

2.What is the specific program/servicefor which the funding is being requested?

  1. Clearly state the name of the program/service.
  1. In no more than 3 lines, briefly describe this program/service.
  1. How will the funding be used?
  1. How will United Way Newfoundland and Labrador funding enhance the program/service?
  1. What is the expected duration of this program/service?Provide the anticipatedstart date and end date – this will be used to determine the timing of allocating funds to all successful grant applicants.
  1. Will this program/service create any new employment?
  1. What percentage of the requested funding would be used to cover salaries?
  1. What funds are being requested for your program/service?

Note:For requests of $10,000+ your latest audited financial statements are required. For requests less than $10,000,United Way NL retains the ability to request your audited financials, if deemed necessary.

4.Other sources of funding:

a. What sources of funding do you currently have for this program/service? Please give specifics in terms of the sources and the amounts.

b. What sources of funding are you currently attempting to put in place for this program/service? Please give specifics in terms of sources and the amountsfor which you have applied.

5.Complete the following budget for the program/service for which you are requesting funds. Please include any amounts listed from Question 4.

Revenue:

Amount / Notes
Grants – Federal
Grants - Provincial
Grants – Other
Members
Number of Members ______
Fee Per Member ______
Donations
In-Kind Donations
Other Revenue (specify)
1.
2.
3.
4.
5.
Prior Years Surplus (deficit)
Sub-Total

Cost:

Total Cost / Amount from UW / Amount from Others / Notes
Salaries & Benefits
Facility Rental
Equipment Costs
Materials & Supplies (please specify)
1.
2.
3.
4.
5.
Travel, Conferences
Utilities
Other Program Expenses (please specify)
1.
2.
3.
4.
Total Expenditure

6.United Way NL has threekey Focus Areas, as listed below. Please select theONEFocus Area that most closely fits with theprogram/service.Type an X in the appropriate column.

From Poverty to Possibility
  • Moving people out of poverty
  • Meeting basic human needs (Ex: food, shelter, and jobs)
/
Healthy People, Strong Communities
  • Improving access to social and health-related support services
  • Supporting resident and community engagement
  • Supporting community integration and settlement
/
All That Kids Can Be
  • Improving access to early childhood learning and development programs
  • Helping kids do well at school and complete high school
  • Making the healthy transition into adulthood and post-secondary education

7.Is this program/service new or existing?

  1. If it is an existing program, please provide details of the length of time the program has been operating.
  1. If this is a new program, have you attempted to offer a program of this nature before?
  1. If so, provide details of when it was last attempted or run previously, and please give a brief explanation of why it was discontinued.

8. a. Are you aware of any other Agencies in your region that offer this type of program?

b. If yes, provide details.

Please Note:Your answers to questions 9 through 12 will guide you once your program/service is completed and you begin your reporting process. These questions will highlight the need for the program/service and its goals. If your Agencyis successful in obtaining funding, these questions will form the basis of the required Funding Report.

9.Outline the rationale and need for this particular program/service.

10.What are the specific outputsexpected of the program/service?

11.What are the specific outcomesthat come from the outputs of the program/service?

12.Describe the related indicators to be utilized by the program/service. Note: If you plan to use surveys, or interview questions, provide a copy of the proposed survey or interview questions.

13.Would you typically evaluate your programs/services? If yes, provide details.

14. Have you conducted any evaluations of this program/service to date?If so, provide a summary of the results of that evaluation.

15. a.How will this program/service build the capacity of the targeted population or group?

b. How does your Agency in general increase the capacity of the population or group?

16.Complete the following charts. Place an X in the appropriate column(s) indicating the region/demographic that will be directly impacted by this specific program/service.

Region / Avalon / Eastern / Central / West & Southwest / Northern Peninsula / Labrador
X
Size of Population Served / Under 50 / 51-100 / 101-250 / 251-1000 / 1001-5000 / 5001+
X
Age of Population Served / 0-5 years / 6-12 years / 13-19 years / 20-25 years / 26-59 years / 60+ years
X
Gender of Population Served / Male / Female / Both
X

Provide a list of specific communities that will be serviced by your program/service:

17.Are there any other specific details about the program/service that you would like to add?

18.Is there anything else you would like to describe about yourAgency in general that was not yet mentioned?

Ensure the signing authorities of your Agency sign the signature sheet on the following page.

Please complete the ‘Final Checklist’ (last page), to ensure you have completed all aspects of your application before submitting.

This application must be signed by two individuals authorized to bind your Agency

Name (please print)Name (please print)

TitleTitle

SignatureSignature

Date Date

Funding Application Checklist:

Check all the boxes to ensure you have included all necessary components of your application.

Failure to include all required components may result in a declined application. Please understand, as awareness and demand for this funding opportunity continues to rise, administratively it becomes increasingly difficult to coordinate the missing pieces of incomplete applications.

□Section A: Agency Details Complete

□Section B: Program/Service Details Complete

□Signature Sheet has been Signed

□All Supporting Documents Attached

  • Signed Letter of Support (If using a partner’s charitable number)
  • Most Recent Audited Financial Statements (for requests $10,000+)
  • Current Board of Directors List
  • Most Recent Annual Report or Board Report