2022-2023 AGENCY PROGRAM: Year-End REPORT For United Way of East TN Highlands Agencies Please fill out the form below Reach out to abraham Mcintyre with any questions: 423-220-1235 | amcintyre@unitedwayetnh.org Due: April 28, 2023 Step 1 of 8 12% Agency Name(Required)Your Name(Required) First Last Please send a copy of these responses to (insert email address)(Required) Name of Program Funded (if applicable)Please upload a PDF of your program funding budget.(Required)Accepted file types: pdf, Max. file size: 100 MB.This is the excel file that was provided by United Way of East TN Highlands that shows the amount of your grant and a way to track the expenses associated with the grant.Describe in summary major activities of your agency's program from the prior 6 months of service.(Required)What assistance other than Impact Grant funding would United Way of East TN Highlands be able to assist you in accomplishing?(Required)Did your agency program receive recommendations for action from the Impact Grant Committee? If so, how are you addressing them?(Required)What significant challenges/opportunities exist for your agency program in the next 6 months? Is there a current plan to tackle these issues?(Required)What gaps in service are you seeing in our area?(Required)How many volunteers has your organization worked with in the past 6 months on the program supported by United Way of East TN Highlands?(Required)Which of our following categories describes your program?(Required) Health Education Financial Stability Select All Individuals ImpactedFor the prior 6 months, please provide the number of individuals (unduplicated) your agency program served in each of the following areas:Washington County(Required)Carter County(Required)Johnson County(Required)Southern Sullivan County(Required) Demographic DataUsing the data you have, please estimate the overall number of people your agency serves that fall into the following demographic categories. If you do not have a breakdown for a particular category (age, gender, etc.), leave the category blank. Put "0" for any group your agency does not directly serve (e.g. children ages 0-9). In other words, "0" = we serve no one in this group, blank = we have no data regarding this group.AgeYoung Children - Ages 0-9Please enter a number greater than or equal to 0.Pre-Teens & Teenage Children - Ages 10-18Please enter a number greater than or equal to 0.Young Adults - Ages 19-29Please enter a number greater than or equal to 0.Adults - Ages 30-64Please enter a number greater than or equal to 0.Older Adults - Ages 65+Please enter a number greater than or equal to 0.Race & EthnicityAsian, Hawaiian, or Pacific IslanderPlease enter a number greater than or equal to 0.Black or African AmericanPlease enter a number greater than or equal to 0.American Indian or Alaska NativePlease enter a number greater than or equal to 0.White or CaucasianPlease enter a number greater than or equal to 0.Hispanic / LatinexPlease enter a number greater than or equal to 0.OtherPlease enter a number greater than or equal to 0.GenderMalePlease enter a number greater than or equal to 0.FemalePlease enter a number greater than or equal to 0.Non-binaryPlease enter a number greater than or equal to 0.Income Level(As it pertains to the Federal Poverty Line)Low-IncomePlease enter a number greater than or equal to 0.Not Specifically Low-IncomePlease enter a number greater than or equal to 0.Sexual OrientationHeterosexualPlease enter a number greater than or equal to 0.LGBTQ+Please enter a number greater than or equal to 0.OtherPlease enter a number greater than or equal to 0. HealthIf there are no questions listed below, you did not select "health" as a category to describe your program. If this is accurate, please click "Next" to continue. If you meant to choose health, please return to the first page by using the "Previous" button to change your response on page one.Total number of volunteers you dedicated to health aspect of funded program:(Required)Did you work with any other agencies to deliver your health programming?(Required) Yes No If yes, please list those agencies.Total number of adults served with health programming:(Required)If your program provides medical care, please enter the number of visits, surgeries, medically assisted treatment appointments (substance use disorder), or mental health sessions that you have been involved with in the past 6 months:(Required)Does your agency offer transportation to receive this health care?(Required) Yes No Number of "at risk" persons served in the health program receiving services for reducing those risky behaviors:(Required)Number of "at risk" persons involuntarily (assigned through DCS, courts, probation, etc.) served in the health program receiving services for reducing risky behaviors:(Required)Number of "at risk" persons served in the health program receiving services for reducing those risky behaviors:(Required)Number of "at risk" persons served in the health program receiving services for reducing those risky behaviors:(Required) Childhood SuccessThis section deals with children from 0-9 years ONLY. If there are no questions listed below, you did not select "education" as a category to describe your program. If this is accurate, please click "Next" to continue. If you meant to choose education, please return to the first page by using the "Previous" button to change your response on page one. Total number of volunteers supporting your childhood success for your funded program:(Required)Please enter a number greater than or equal to 0.Total number of children (0-9) that participated inthe program:(Required)Please enter a number greater than or equal to 0.Did you work with other agencies to provide your programming?(Required) Yes No If yes, please listTotal number of children (0-5) enrolled in your children's programming:(Required)Please enter a number greater than or equal to 0.Total number of children served receiving literacy supports from programming:(Required)Please enter a number greater than or equal to 0.Total number of children served wtih STEM education programming:(Required)Please enter a number greater than or equal to 0.Number of families or caregivers served that are provided with information, resources, tools, trainings and/or teachings of skills:(Required)Please enter a number greater than or equal to 0.Number of children served that reached developmental milestones in achieving school readiness or grade level success from program:(Required)Please enter a number greater than or equal to 0.Number of children served who had success in gaining proficiency to grade level readiness:(Required)Please enter a number greater than or equal to 0.If an afterschool care program, how many months out of the last 6 months did you reach allowed capacity for your agency?(Required)Please enter a number greater than or equal to 0.How many people are currently on your waitlist for afterschool programming?(Required)Please enter a number greater than or equal to 0.Do you provide food for your programming?(Required) Yes No Only on occasion If yes, how many meals and snacks do you provide daily?(Required)Please enter a number greater than or equal to 0.Are you an active member of the United Way of East TN Highlands' Tennessee Afterschool Network?(Required) Yes No Youth SuccessThis section deals with children from 10-18 ONLY. If there are no questions listed below, you did not select "education" as a category to describe your program. If this is accurate, please click "Next" to continue. If you meant to choose education, please return to the first page by using the "Previous" button to change your response on page one. Total number of volunteers in youth programming:(Required)Total number of youths served in the past 6 months within your program:(Required)Did you work with other agencies to provide this program?(Required) Yes No If yes, please listNumber of youth served in afterschool program:(Required)Number of youth in program graduating or on track to graduate on time:(Required)Number of youth that received information on post education programs in either higher education or concentrated skilled technology:(Required)Number of youth or caregivers served that are provided with information, resources, tools, trainings, and/or teaching of skills:(Required)Number of youth in programs that were elevated to roles as peer mentors:(Required)Number of youth in program that are not voluntary placement (court ordered, DCS mandated):(Required)Number of youth that are not reading at grade level proficiency in your program:(Required)Number of youth that receive academic tutoring assistance(Required)Number of youth families referred from other agencies(Required)Number of meals provided to youth:(Required) Financial StabilityIf there are no questions listed below, you did not select "financial stability" as a category to describe your program. If this is accurate, please click "Next" to continue. If you meant to choose financial stability, please return to the first page by using the "Previous" button to change your response on page one. Number of volunteers for financial stability program:(Required)Total number served by the program in the last 6 months:(Required)Number of individuals that received job skills training:(Required)Number of individuals that requested access to affordable housing loan, financial products or services, budgeting or tax assistance:(Required)Number of individuals requested help with housing stability or homeless prevention (rent/mortgage, hotel room, etc.):(Required)Number of individuals receiving assistance for utilities:(Required)Number of individuals referred to United Way of East TN Highlands' Financial Empowerment Center:(Required)Number of referrals to other agencies for client services:(Required)Did you work with other agencies on your financial stability programming?(Required) Yes No If yes, please list: Additional HelpThese questions are to help us understand how we can better serve your agency.Is your agency trained in Naloxone education and how to administer it?(Required) Yes No Partially Is your agency trained in Adverse Childhood Experiences?(Required) Yes No Partially Is your agency trained in Trauma Informed Care?(Required) Yes No Partially Does your agency have a marketing plan for the program?(Required) Yes No Partially Does your agency have a trained grant writer?(Required) Yes No Has your agency done a five-year plan of operation or a SWOT or other analysis to identify strengths and weaknesses in the program?(Required) Yes No Is there anything we failed to ask that you think is important for us to know?Would you like to share any success stories with us?
