2024 Grant Application Requests for Funding 2024 The information provided in this application will be shared with those participating in our grant review process. Download a PDF Version 2023 Grant Application Organization & Contact Information Name of Organization * Physical Address * Mailing Address * Phone * Website/URL Executive Director Executive Director Phone Executive Director Email Contact Person * Contact Person Phone * Contact Person Email * Is your organization an IRS 501c3 not-for-profit? * Yes No If no, is your organization a public agency / unit of government? Yes No If no, is your organization registered with the State of Minnesota as a non-profit? Yes (provide copy) No 2023 Funding Request Actual allocation for 2023 If you did not receive funding in 2023, have you received funding in a previous year? Yes No 2024 Funding Request 2024 Funding Request Please select the area your grant request addresses: Basic Needs – Providing basic needs/crisis emergency services Education – Helping children, youth, and adults achieve their full potential Health – Improving people’s health and social well-being Please describe your organization’s primary function or goal Please provide a description of the project or program for which you are requesting funding. What identified community need(s) will your project address? What are the goals of your project or program? What is the target population that you will serve? Please include approximate number of people who will be served, age range, gender, race, and income level. (Please note: If you receive funding, you will need to provide specific demographic information for those actually served in your final report.) What is the geographic area served by your organization or program? What is the timeframe for your service or program? Ongoing, year-round Seasonal If seasonal: Start Date: If seasonal: End Date: How will you make the target population aware of this service or program? How will people access this program? Describe the outcome or impact that this service or program will have in the community. How does this impact meet the Delano Loretto Area United Way funding priorities (Basic Needs, Education, Health)? How will you evaluate your project / program to determine success? Describe your organization’s relationship with other organizations with similar missions working in our service area. Do you collaborate with them? If so, how? List your Board of Directors members and indicate officers: How often does your Board of Directors meet? Budget Please provide the budget for this program or project: Delano Loretto Area United Way: Proposed Amount Delano Loretto Area United Way: Precent of Total Revenue Source 2 (specify) Source 2 Proposed Amount Source 2 percent of total budget Source 3 (specify) Source 3 Proposed amount Source 3 percent of total budget Source 4 (specify) Source 4 Proposed amount Source 4 percent of total budget Source 5 (specify) Source 5 Proposed amount Source 5 percent of total budget Total proposed revenue Expenses Please provide the expense information for this program or project: Personnel expense: Proposed amount Personnel: percent of total budget Supplies: Proposed amount Supplies: percent of total budget Advertising and Printing: Proposed amount Advertising and Printing: precent of total budget Travel: Proposed amount Travel: percent of total budget Rent and equipment: Proposed amount Rent and equipment: precent of total budget Professional fees: Proposed amount Professional fees: precent of total budget Fee reductions / waivers: Proposed amount Fee reductions / waivers: percent of total budget Other expenses: specify the type of expense, proposed amount and percent of total budget for each item. Total expenses What is the total annual budget for the organization? If there are fees required for participation, will reduced fees or fee waivers be made available to those with demonstrated financial need? If yes, how will you determine financial need? If you are requesting an increase over last year, what is the reason for the increase? Does your organization publish an annual report or make an annual financial statement available to contributors? Yes No Anti-Terrorism Compliance Measures In compliance with the USA Patriot Act and other counterterrorism laws, the Delano Loretto Area United Way requires that each organization certify the following: “I hereby certify on behalf of _______________________________________ (insert organization name) that all Delano Loretto Area United Way funds and donations will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes and executive orders.” Organization Name Name of certifying individual Title Date In compliance with anti-discrimination laws, Delano Loretto Area United Way requires that each organization certify the following: “I hereby certify on behalf of ________________________________ (insert organization name) that the opportunity for participation in all our programs and services supported by Delano Loretto Area United Way funds and donations granted to our organization will be offered without discrimination on the basis of race, color, creed, religion, national origin, sex, marital status, familial status, public assistance status, age, sexual orientation, or local Human Rights Commission activity. Our organization also makes reasonable accommodations for individuals with disabilities.” Organization Name Name Clicking “I Agree” confirms your signature: Entering your signature information and clicking “I Agree” certifies that your Board of Directors / Advisory Committee supports this application, that it is accurate, and that the project will be carried out as described if funded. * I agree I do not agree Title Date Electronic Signature Electronic Signature * Clicking “I Agree” confirms your signature: Entering your signature information and clicking “I Agree” certifies that your Board of Directors / Advisory Committee supports this application, that it is accurate, and that the project will be carried out as described if funded. * I agree I do not agree Submit If you are human, leave this field blank.
