Grant Application 2025-2028 - Part 4

Listing the following email addresses will allow for copies of the submission of this form to be emailed to you once submitted.
Is the Local Contact Person's email the same as Chief Executive Officer's email?
Is the Program Director's email the same as Local Contact Person's and/or the Chief Executive Officer'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?

Organizational Financial Statements

The following documents and questions are required from the Lead Organization. Note: If the Fiscal Agent is NOT the same as the Lead Organization, the Fiscal Agent must provide Agency Profit and Loss Statement, Organizational Financial Statements and Federal Tax Return.
 

Include budget vs. actual for the most recently completed fiscal year.
Upload requirements
Include budget vs. actual for the most recently completed fiscal year.
Upload requirements
Upload requirements

Organization Financial Status

Audited, reviewed or compiled organizational financial statements.
Is your organization a tax-exempt organization under 501(c) of the Internal Revenue Code?
Tax-Exempt Organizations
What is your annual revenue?
Please upload a statement that the following have been reviewed and approved by the board treasurer and chairperson. This statement must be verified with signatures.
  • Program Profit & Loss Statement
  • Agency Profit & Loss Statement
  • Balance Sheet
  • Cash Flow Statement for the most recently completed fiscal year (if possible)

Upload requirements
A formal "review" of the following documents by an independent certified public account is required.
  • Program Profit & Loss Statement
  • Agency Profit & Loss Statement
  • Balance Sheet
  • Cash Flow Statement for the most recently completed fiscal year (if possible)

Upload requirements
Audited financial statements and the opinion of an independent certified public accountant of the following documents is required.
  • Program Profit & Loss Statement
  • Agency Profit & Loss Statement
  • Balance Sheet
  • Cash Flow Statement for the most recently completed fiscal year (if possible)

Upload requirements
Not Tax-Exempt Organizations
What is your annual revenue?
Please upload a statement that the following have been reviewed and approved by the executive director. This statement must be verified with a signature.
  • Program Profit & Loss Statement
  • Agency Profit & Loss Statement
  • Balance Sheet
  • Cash Flow Statement for the most recently completed fiscal year (if possible)

Upload requirements
A formal "review" of the following documents by an independent certified public account is required.
  • Program Profit & Loss Statement
  • Agency Profit & Loss Statement
  • Balance Sheet
  • Cash Flow Statement for the most recently completed fiscal year (if possible)

Upload requirements
Federal Tax Return
For the most recently completed fiscal year (e.g., 990, 1040).
Upload requirements
Financial Narrative Questions
Has the organization obtained any long term (greater than 1 year) debt over the past year?
Have there been any large changes in income or expenses over the last year?
Some examples might include:
  • Addition or termination of employees
  • Significant one-time donations
  • Elimination of a donor source (i.e. revenue received in past years ceases)
  • New phone, computer system, or other such capital purchase
Is the organization’s actual net income within 15% of budgeted net income?
If an existing program, is the program’s proposed budget for the coming year(s) in alignment/appropriate compared with the previous year’s actual results?
Any other insight that would explain any other revenue or expense anomaly that would help the reviewer?
Fiscal Agent
Is the Fiscal Agent the same organization as the Lead Organization or one of the Collaborative Organization?
An additional signature is not needed.
The Fiscal Agent must provide Agency Profit and Loss Statement, Organizational Financial Statements and Federal Tax Return. Please send them this link:https://www.uwgcv.org/form/grant-application-part-4-fiscal.
Lead Organization
Sign above