Form - RFP - United Way of Pottawatomie County

Organization Name(Required)

Organization Tax ID(Required)

Executive Director(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Mission Statement(Required)

Number of Employees(Required)

Program Name(Required)

Amount of funding requested(Required)

List the specific local need(s) that this program addresses(Required)

List data points and sources that demonstrate this local need(Required)

Describe the program including frequency, duration, cost (if any) to participants, and activities(Required)

Explain how the program will address these local needs(Required)

List demographics of those served by this program(Required)

List the measurement tools/methods that will be utilized to track progress and/or efficacy of the program(Required)

List evaluation results/data points from this program for 2022(Required)

How many individuals will be served by this program? (Unduplicated)(Required)

How many individuals did you serve with this program last year? (Unduplicated)(Required)

How many individuals actively participate with organization?(Required)

If the organization serves local youth under 18 years old, list the current organizational training(Required)

List any other funding sources and amounts for this program.(Required)

If Applicable: please outline how United Way of Pottawatomie County 2022 funding was utilized.

Most Recent Audit Report(Required)