United Way e-Community

Butler County United Way Request for Funding Survey

Is your agency 501(c)3 designated?

Yes

Is your agency a government unit?

Yes

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

* How long has your agency been established?

* Legal name of agency:

* 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 - The program would not be possible without a partnership with others. It is not who you provide the service to, it is who you provide it with to make it successful.

* 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 in at least one of our Impact Areas - Youth Opportunity (early childhood education, ages 0-12), Healthy Community (mental health and substance abuse awareness), Financial Security (housing security and other tools for financial freedom), and Community Resiliency addressing community crisis needs).

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

* How much funding support are you seeking to make your program successful?

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

* Who do you currently 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