Organization Information Organization Name: Contact Person: Address: E mail: Organization Mission:

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1 nited Way of Southern Kentucky 2019 Community Impact Letter of Intent Please complete the following form and return it to nited Way of Southern Kentucky (WSK) by 4pm, Friday October 19, Submission by is required. An invitation to fill out a full Community Impact Application will be issued to agencies whose programs fit the nited Way of Southern Kentucky's community impact goals and priorities. Letter of intent is required of all agencies, regardless of past nited Way support. Please fill out a separate LOI for each program (multi county program is one Letter of Intent) for which you are applying. You may use this document and one additional page if needed to complete the LOI. Please note that completion of this form does not guarantee funding or the advancement to the second round of the funding review process via an invitation to complete the full community investment application. Organization Information Program Name: Organization Name: Contact Person: Address: E mail: Phone: Fax: Organization Mission: Organizational Status: 501 (c) 3 Other (Specify) AMONT REQESTED BY CONTY: $ (TOTAL FOR ALL CONTIES) (Indicate amount per county below) Allen Barren Butler Edmonson Hart Logan Metcalfe Monroe Simpson Warren 3

2 Program Focus Area: Community Impact (Please select the ONE primary outcome that your program will deliver. For Example: Education/Kindergarten Readiness/Increase early learning opportunities, Focus Area and Strategy including early literacy and language.) Education Prepare children, youth & young adults to succeed in school and life. Kindergarten Readiness Improve early learning environments and increase access to high quality licensed child care programs for children and families, particularly those of low income and educational risk. Increase early learning opportunities, including early literacy and language development. Provide resources, education and other needed supports for families and caregivers to bolster their child s age appropriate development. Collaborate to create and implement a comprehensive high quality approach to school readiness. College & Career Readiness Improve the connection between school and work for disconnected youth through career and technical education, apprenticeships, work study and other innovative education approaches. Increase the availability and use of postsecondary assessment tools. Provide quality out of school opportunities that reinforce and enhance learning and preparation for future success. Increase the preparation and soft skill development of students for post secondary opportunities/choices. Income People have the appropriate skills to maintain a living wage employment. Workforce Development Increase/create employment opportunities for individuals with felony records through training/reengagement in education, educating employers and connection with services to help secure employment. Provide support and education on training/post secondary programs for individuals that have graduated high school but have not moved on to post secondary programs and/or do not have sustaining employment. Provide opportunities for individuals that are under employed to access employment matching their skill set. Increase knowledge of, and access to, training and education opportunities for unemployed individuals with focus on returning them to the active workforce. Health Increase access to quality, affordable health and crisis intervention services. Access to Affordable Health Care Increase the number of eligible individuals that are enrolled in viable health care coverage options. Increase the number of qualified professionals and patient access for medical care needs including under-served needs like mental health, prenatal care, dental care and substance abuse treatment. 4 Provide education programs designed to improve long-term health including navigating the health care system, substance abuse prevention, mental health,wellness, smoking cessation and obesity reduction/prevention.

3 Community Impact Focus Area and Strategy (continued) Safe Home & Community Reduce the impact of violence on individuals and families through safe and accessible emergency shelter and crisis services. Provide education programs to reduce the incidence and impact of family and individual violence including violence prevention, parenting education and public awareness. Safety Net Basic needs are met in a timely manner through a coordinated system of resources Transportation Increase viable transportation options across our communities including, but not limited to, volunteer driver programs, access to low cost vehicles and/ or car loans and alternative, environmentally friendly modes (ex. bicycles, mopeds). Provide financial supports for low income (200% of poverty and below) households to access current mass transit routes. Provide transportation options for employment or employment related activities (job fairs, training, etc.) or basic needs (food, medical appointments, housing, etc.) Access to Basic Needs Emergency Assistance Provide emergency assistance (food, clothing, shelter, furnishings and utility assistance) to individuals who are homeless or in a financial crisis, incorporating efforts to return the individual to self sufficiency. Housing Increase rental housing sustainability supports including financial assistance for low income (200% of poverty and below) households, and consumer education opportunities for financial literacy and renter/landlord rights & responsibilities. Increase the availability, and consumer knowledge of availability, of safe, affordable and habitable housing. Decrease total housing costs for low income households through improved energy efficiency of dwellings. Food Provide options for healthy and affordable food choices that include nutrition and healthy meal planning education, with focus on reducing both food deserts and service duplication. Clothing Increase options and access for work related apparel and accessories. (check all that apply) CONTIES SERVED: Allen Barren Butler Edmonson Hart Logan Metcalfe Monroe Simpson Warren 5

4 PROVIDE INFORMATION ONLY IN THE SPACES BELOW. Program Description: PROGRAM INFORMATION Please provide brief, but specific information about the program for which you are seeking funding (not your entire agency). Is this a new or established program for your organization? New Established (Date Established) Description of program goals and expected outcomes (by county if multi county program) WHAT ARE YOR SPECIFIC OTCOMES- please be detailed as possible What do you hope to achieve How many people will this program serve Who is your primary client How will you utilize nited Way funding How are program outcomes measured? For example, every client, random sample, type of tool pre/post, phone call, web based survey, etc. If this program is an existing program, please provide specific outcomes for the past year. Please be detailed as possible. 6

5 How will this program contribute to the WSK Impact Goals that you indicated? PROGRAM INFORMATION Please provide brief, but specific information about the program for which you are seeking funding (not your entire agency). Is this program a collaboration? Yes If yes, Include: No 1. Names of the entities with which the program collaborates/partners. 2. Function or role of the partner (for example - shared resources, referrals, decision-making, accountability, funding, etc.) 7

6 PROGRAM INFORMATION If you are applying for funding for an existing program that is not currently receiving nited Way funding, in the space provided, please explain how you will utilize WSK funding to expand or improve the existing program. What additional elements would you add to the existing program? How will the additional funds allow you to serve more clients or improve you delivery of services? Please provide brief, but specific information about the program for which you are seeking funding (not your entire agency). In some cases, nited Way may not be able to fully fund all proposals. In the space provided, summarize how your proposal will be affected if nited Way can only provide partial funding of the amount that you have requested. Would you be able to implement the proposal by utilizing other funding sources? If you would be required to make adjustments to the proposal, what would it entail? Budget Information Identify Program's Yearly Cycle TO Provide the following PROGRAM budget information, rounding to the nearest dollar. Estimated funding request from WSK Estimated revenue from ALL OTHER sources $ $ TOTAL expenses $ TOTAL unduplicated number of people to be served by the program Please return by to communityimpact@uwsk.org by 4pm, Friday, October 19,

7 DO YO MEET THE FOLLOWING NITED WAY OF SOTHERN KENTCKY MINIMM STANDARDS: OR AGENCY: Is a current nited Way funded agency that meets all of the minimum standards. Is a new agency applying for funding that meets all of the minimum standards. Is a new agency applying for funding that does not currently meet all of the minimum standards (see below) but will commit to work towards achieving the minimum standards in a mutually agreed to timeframe. PLEASE CHECK THE STANDARDS THAT APPLY BELOW TO YOR AGENCY: GOVERNANCE 1. The agency is incorporated. 2. The organization is a nonprofit with tax exempt status under the IRS code. Select Status: 501(C)(3) Other (Please list status) Has own IRS Determination OR Subsidiary Covered nder Another Organization s IRS Determination 3. The agency is governed by a board that meets regularly, operates with a quorum, and records minutes of all meetings. 4. The agency volunteer board is governed by bylaws which are reviewed annually and ratified or revised as needed. 5. Board members must serve without compensation. No paid staff of the agency may serve as a voting member of the board. 6. The board controls the fiscal affairs of the organization, including the development and adoption of an annual budget and written financial policies and procedures. 7. The agency must have been actively conducting business for at least two years. SE OF FNDS 8. The agency with an annual budget of $500,000 or more has an independent audit; agencies with an annual budget of $100,000 $499,000 has a review completed by an independent auditor; or, in the case of an agency having a budget below $100,000, a compilation conducted annually by a certified public accountant. 0B 9. The agency must be willing to comply with all financial reporting requirements. 10. The agency has outlined its goals in a long range or strategic plan and the use of funds is in accordance with the mission. 11. Each program has an annual operational plan with quantifiable outcomes that specify the results to be achieved during the defined time period. 12. There is a system in place to measure progress on achieving outcomes and to report progress to the board. 9

8 ADMINISTRATION 13. The agency has insurance coverage commensurate with the risks associated with its programs (property, general liability, professional liability, fidelity bond, directors and officers liability, vehicle, etc.). 1B 14. The agency has an affirmative action policy or a policy on cultural diversity for its staff, governing body, and services. 15. The staff is sufficiently qualified by training and experience. 16. The agency has written personnel policies approved by the board and available to the entire staff. 17. Facilities meet applicable federal, state and local codes, including access, fire and safety codes. 18. The organization conforms to key Sarbanes Oxley Act standards. We certify that, to the best of our ability, the information contained in this application is true and correct. Signature of Board President (or equivalent) Signature of Executive Director (or equivalent) Printed Name Printed Name Date Date 10