Allocation Form

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 2017
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

Save and Continue Later

Instructions

Complete & submit allocations form.
Submit the following documentation.

Federal Form 990 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

Instructions

Roscommon County United Way

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