2023 Social Innovation Grant Application Step 1 of 4 25% Agency InformationName of Nonprofit Organization*Program Name*Is your program part of a nonprofit organization?* Yes No What type of nonprofit is your program a part of?*501(c)3City, County, or StateSchool or AfterschoolReligious OrganizationNonprofit Executive Director*Email Address* Name of Program Contact*Email Address* Mailing Address*City / State / Zip*Phone NumberIs your program under two years old?* Yes No If your program has already started, when did it begin? (Month & Year)*If your program has not yet launched, please provide your expected start date (month & year). If your program has already started, please put "N/A."*Which United Way focus area does your program address?* Select All Health Education Financial Stability Program OverviewWhat is your organization's Mission Statement?*Explain and provide current data of the community need for this program. (Max: 1,500 characters or roughly 300 words)*Describe the program you would like to receive funding for; why it is socially innovative, and list any new technologies or systems you will implement to achieve impact. (Max: 2,000 characters or less roughly 400 words)*Describe how you hope your innovative program brings long-term or short-term impact to the community. Please elaborate on how this is different than current practices. (Max 1,500 characters or roughly 300 words)*Which county or counties in our area will your program support?* Select All Washington Carter Johnson Southern Sullivan How many people do you hope to directly impact with this program?Briefly explain how your program is/would be staffed (paid employees, volunteers, etc.) (Max: 1,000 characters or roughly 200 words)*Please provide the total program budget.This is for the specific program, not the organization's total budget.Do you have other sources of funding in place for this program? If so, what percentage of the program budget do they cover? If you do not have other sources of funding for this program, put 0%.What are the program's top three goals and how will you measure success for each? (Max: 1,500 characters or roughly 300 words)* Additional InformationOutline the demographics of the intended recipients (age group, gender, socioeconomic status, specific requirements, etc.). (Max: 1,000 characters or roughly 200 words)*How do/will you market/communicate your program to the community? (Max: 500 characters or roughly 200 words)*Do/will you partner with other agencies/organizations in the community to accomplish your program's mission? If so, briefly describe who and how?* Consent* I agree to the Statement of AgreementAs a funded agency of the United Way of East TN Highlands we accept the following principles and conditions: A. BOTH UNITED WAY OF EAST TN HIGHLANDS AND THE PARTNER AGENCY AGREE 1. To maintain an active, rotating volunteer structure which assumes and fulfills the responsibility of managing its affairs within the scope and spirit of respective by-laws and this agreement. 2. Offer opportunity for participation in programs, services, policy designation and staff employment to persons regardless of race, religion, age, sex, national origin, sexual orientation, and disability. 3. To strive to increase the public's understanding and appreciation of and participation in human services programs. 4. To consult and work together on matters of common interest in an effort to achieve the best interest of the community as a whole. B. THE AGENCY AGREES 1. To maintain a positive and supportive relationship with United Way and the United Way Staff in all communications and throughout the community. 2. To engage in an effective year-round public relations program in which the objectives, services and accomplishments of the Agency, and the United Way of East TN Highlands support of such services, are adequately publicized. 3. To provide a semi-annual report to the United Way of East TN Highlands indicating the number of clients served and the impact results of the program being funded. (format to be provided). 4. To carry out the programs of the agency in such a manner as will best meet the needs of the community and will be consistent with standards of service, efficiency and economy. 5. The agency is encouraged to participate in the following events: Quarterly Partnership Meetings Week of Caring event in the 3rd Week of June C. THE UNITED WAY OF EAST TN HIGHLANDS AGREES 1. To provide resources to strengthen partner agencies. 2. To respect the agency's prerogative of determining its own policies and programs within the community. 3. To use its best efforts to achieve the campaign objectives and fund Agency Programs that are making significant impact in the categories of Health, Education, and Financial Stability. 4. To act as responsible stewards of funds publicly contributed to the United Way by fully informing contributors of the allocations and use of the funds.Electronic Signature of Agency Executive Director / CEO or Program/Project Contact (Please type your name below.)*Today's Date* MM slash DD slash YYYY
