2023-24 Partnership Inquiry Form Organization InformationOrganization Name(Required) Website Address(Required) In what year did the applicant agency receive 501(c)3 status from the Internal Revenue Service (IRS)?(Required) Mission Statement(Required)Service Area (check all that apply)(Required) Washington County Carter County Johnson County Southern Sullivan County Select AllFocus Area (check all that apply)(Required) Health Education Financial Stability Select AllHow many Full Time Employees does the organization employ?How many Part Time Employees does the organization employ?Contact InfoPlease provide the contact information for your organization's Executive Director and the development/grant writing staff who should be contacted about your inquiry.Executive Director Name(Required) First Last Executive Director Email(Required) Executive Director Phone Number(Required)Grant Writer Name (optional) First Last Grant Writer Email (optional) Grant Writer Phone Number (optional)Organizational CapacityPlease list the goals of your organizations' strategic plan over the next 1-2 years:(Required)Please share your organization's anti-discrimination / inclusion statement. Write "N/A" if your organization does not currently have one in place.(Required)Briefly describe the specific target population in your community that your organization aims to serve.(Required)Programs & ServicesPlease describe how your organization aligns with United Way's mission to break the cycle of poverty.(Required)Please briefly describe your partnership with United Way of East TN Highlands over the past 12-months. Include information (if applicable) on running a Workplace Giving Campaign, Week of Caring Project, or other programmatic partnerships.(Required)Please list local nonprofits that you partner with:(Required)DocumentsDo you agree, if chosen to move forward in this process, to produce the following most up-to-date documents?Current list of Board of Directors(Required) Yes No 501(c)3 Approval Letter(Required) Yes No Charitable Solicitation Registration(Required) Yes No Audit or Financial Review (Tier Dependent)(Required) Yes No Current Financials, to include: Income Statement & Balance Sheet(Required) Yes No Δ
