Grant Application 2025-2028 - Part 1 | United Way of the Greater Chippewa Valley

Listing the following email addresses will allow for copies of the submission of this form to be emailed to you once submitted.

Chief Executive Officer's Email

Is the Local Contact Person's email the same as Chief Executive Officer's email?

Yes

Local Contact Person's Email

Is the Program Director's email the same as Local Contact Person's and/or the Chief Executive Officer's email?

Yes

Program Director's Email

Do you want to send a copy of the submission of this form to another email address other than the one(s) listed above?

Yes

Additional Email

Select your Impact Area for this Program

Health

Education

Financial Stability

Basic Needs

General Information about Lead Organization

Lead Organization

Name

Federal Tax ID/EIN

Website

Organizational Chart

Reflect on the following structures and how they relate to each other:

Board and committee structure
Departmental structure
Supervisory structure, including position titles

Upload requirements

Upload Organizational Chart here

Board of Directors

List each board member and indicate whether or not she/he/they is an officer, committee assignment, length of board service, employment affiliation and contact information.
Upload requirements

Upload Board of Directors file here

Chief Executive Officer (or equivalent)

Name

Title

Street Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Is your Lead Organization mailing address the same as the street address?

Yes

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Telephone

Local Contact Person

Name

Title

Street Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Is your Local Office mailing address the same as the street address?

Yes

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Telephone

Legal Status of Lead Organization

Fiscal Agent

Name

Legal Status of Fiscal Agent

Has the Lead Organization or Program been part of a government-led investigation?

Yes

If yes, please include why the investigation happened, findings from the investigation, whether or not the agency/program has put put on corrective action or probation and what the agency is doing to correct the issue. Also includes timeframes for each part of the process.

Mission statement of your organization

Max: 200 words

Program Information

Program Name

Website

Program Director

Name

Title

Street Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Is your Program mailing address the same as the street address?

Yes

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Telephone

Status of this program within your organization

Overview, Purpose, and Description of your program

Max: 750 words

Describe your program. If funding is approved, this description will be used in UWGCV marketing.

Max: 100 words

Grant Application 2025-2028 - Part 1

General Information about Lead Organization

Program Information

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