Join the Fight
RFP Process Survey
Butler County United Way Request for Funding Survey
Is your agency 501(c)3 designated?
Select radion button Yes or No.
Yes
No
Is your agency a government unit?
Select radion button Yes or No.
Yes
No
Note: Butler County United Way does not accept requests for funding from agencies without a 501(c)3 certification or qualified government unit.
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How long has your agency been established?
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How many Board members does your agency have?
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Legal name of agency:
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Agency address:
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Website:
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Employer Identification Number (EIN#):
Are you located in Butler County and/or provide a program that serves Butler County?
Select radion button Yes or No.
Yes
No
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What is your program name?
Is this an independent agency program or collaborative with other agencies?
Program - Your agency is the sole provider of services.
Collaborative - The program would not be possible without a partnership. It is not who you provide the service to, it is who you provide it with.
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What other agencies are you partnering with in the collaboration?
Butler County United Way looks heavily at measurable impact and evidence of success. We ask that your program be focused within our Strategic Objectives and Impact Areas:
Strategic Objective: Youth Opportunity - Improve early childhoodeEducation and youth mental health, specifically birth through five years old
Strategic Objective: Financial Security - Improve financialsSecurity with long-termsSolutions, specifically housholds of the threshhold of the federal poverty level (ALICE population - Asset Limited, Income Constrained, Employeed)
Initiative: Healthy Community - Provide mental health support and prevention services
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Please explain how your program fits into one of these criteria.
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What is your desired outcome of the program in the near future?
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What population(s) does the program serve?
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How many unduplicated people does the program serve?
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How much funding support are you seeking to make your program successful?
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What would Butler County United Way funding be used for to make your program successful?
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Who do you currently seek other funding support from in order to ensure a successful program?
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Name of Executive Director:
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Executive Director Phone Number:
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Executive Director Email Address:
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Name of person completing this survey:
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Contact Phone Number:
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Contact Email Address:
Items marked with an asterisk(*) are required
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