United Way e-Community

Butler County United Way Request for Funding Survey

Is your agency 501(c)3 designated?

Yes

Note: Butler County United Way does not accept requests for funding from agencies without a 501(c)3 certification.

* How long as your 501(c)3 been established?

* Legal Name of Organization:

* Agency Address:

* Employer Identification Number (EIN#):

Are you located in Butler County and/or provide a program that serves Butler County?

Yes

* What is your program name?

Is this an agency program or collaborative with other agencies?

Program - Your agency is the only provider of services

Collaborative - Your agency is partnering with other agencies to provide services

* What other agencies are you partnering with in the collaboration?

Butler County United Way looks heavily at measurable impact and evidence of success. Your program should be focused on one of our Impact Areas - Youth Opportunity (pathways for young people), Healthy Community (access to health services), Financial Security (tools for financial freedom), and Community Resiliency (preparation for crisis).

* Please explain how your program fits into one of our Impact Areas.

* What would Butler County United Way funding be used for to make your program successful?

* Who do you seek other funding support from in order to ensure a successful program?

* Name of Executive Director:

* Executive Director Phone Number:

* Executive Director Email Address:

* Name of person completing this survey:

* Contact Phone Number:

* Contact Email Address:

Items marked with an asterisk(*) are required

RFP Process Survey