Organization Name(Required) Organization Tax ID(Required) Executive Director(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 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)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.Program Budget(Required)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.501c3 IRS Determination Letter(Required)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.IRS Form 990(Required)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.Oklahoma State Charitable Registration(Required)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.2023 Board of Directors roster and contact information(Required)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.