Allocation Form

2019 Allocation Year

Health and human service nonprofit organizations with a 501 (c) 3 IRS designation and serve Roscommon County residents can apply to receive funding assistance from United Way.

Fill out the form below to start the process.

Date of Application*
Name of Agency*
First
Name of Program*
First
Contact Person*
First Last
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Email*
Amount Requested in 2018
Amount Requested in 2019
Agency's Mission Statement
Type of Funding
- Continuation
- Expanded
- New
Please give a brief description of the program including the purpose and service(s) provided as it relates to the needs in the community: Attach an additional page if necessary)
Explain why your agency needs the requested funding
Describe the expected outcome(s) for the program
4. Indicate the number of Roscommon County clients served: (un-duplicated count)
What is the total annual budget for this program?
What was the year-end fund balance?
List sources of other funding requests
If funded, how will your agency demonstrate your organization is a funded agency? (Check all that apply)
- Will place Unite Way logo on letterhead
- Will mention during agency presentations
- Will post logo in a visible location in the office
- Other
The United Way campaign is the foundation of the community investments funding. We need your support. When will your agency conduct its 2019 United Way campaign?
Statewide 211 is an essential source of information for people seeking help, professionals seeking assistance for clients, as well as aiding emergency services in times of crisis. The database provides the information available to our communities. It is important that as many organizations as possible are listed in the database. Are you registered with 211 NE MI ?
If you are registered when was your information last updated?
If you are not registered, please contact Hollie Hawkins at 211 NE MI to register your organization or update. Hawkins @211NEMichigan.org

Save and Continue Later

Instructions

Application due no later than April 1^st 2019

Complete & submit allocations form.
Submit the following documentation.

Federal Form 990, audit or financial review for the most recent fiscal year available.
Michigan License to Solicit
A brief description of your program for RCUW campaign materials
A copy of 501 (c ) 3 determination letter

To submit the documents you may scan and email them to: rcuw@roscommoncountyunitedway.org

Or mail them to:
Roscommon County United Way
P.O. Box 1003
Houghton Lake, MI 48629

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Allocation Form

2019 Allocation Year

Instructions

Application due no later than April 1^st 2019

Roscommon County United Way

Menu

Contact Us

Allocation Form

2019 Allocation Year

Instructions

Application due no later than April 1st 2019

Roscommon County United Way

Menu

Contact Us

Application due no later than April 1^st 2019