United Way of the Plains 2015 Letter of Intent Instructions For Funding Jan.1 Dec. 31, 2016 United Way of the Plains provides funding for nonprofit health and human service organizations located in Butler, Sedgwick, and Sumner counties. This is a multi-step process that begins with a Letter Of Intent (LOI). The Letter of Intent provides a very broad but concise description of the program to be funded and the anticipated program outcomes. The full Letter of Intent application consists of 25 copies of each LOI and one agency information packet that consists of a copy of: your agency s 501(c)3, your most recent audit, and a current agency board roster. If your agency is interested in applying for 2016 funding for multiple programs, you will need to include a Letter of Intent application for each program to be considered but only one copy of the agency information packet. LOIs are due to United Way of the Plains by 5:00 p.m. on March 13, 2015. All applicants will be notified in writing regarding the disposition of their Letter of Intent application by May 8, 2015. Included in this instructional packet are copies of the Funding Eligibility Policy, 2016 Funding Priorities, and 2015 Allocation Important Dates. The latter will enable your agency to plan for the next phase of requirements and training. If you have questions, please contact Melinda Ball at 316-267-1321. Submission Instructions 1. The Letter of Intent (LOI) is in a fillable pdf format. If you have more than one program you would like to have considered for funding, remember to save each completed form separately, so that you retain the original form template. 2. Use only the form provided. The form is designed to be copied front to back and consists of only 1 page. 3. Submit 25 COPIES of each Letter of Intent on plain white 8½ x 11 inch paper, which has been copied two-sided. DO NOT punch or staple copies. 4. Do not submit a cover letter. It will be discarded. 5. Provide one agency information packet, consisting of a copy of your agency s 501(c)3, your most recent audit and a current agency board roster. 6. All Letters of Intent and agency information packets are due to United Way of the Plains by 5:00 p.m. on March 13, 2015.
Letter of Intent Form Applicant Organization List the name of the organization as it appears on your 501(c)3 or as you are known by the general public. Address, City, State, Zip Physical location where services are rendered. Phone Agency phone number. Fax Email Agency fax number. Email address of individual identified as contact person. WWW Agency website, if applicable. Contact Person Name of person to contact with questions about the program/letter of Intent. This may be the agency s executive director or program manager. Title Job title of individual identified as contact person. How Long Has Your Agency Been In Existence? Indicate in years how long the agency has been in business. Agency Mission The mission of the agency. Fiscal Year Period or timeframe used for accounting purposes and preparation of financial statements. Date of Last Audit Date on which your agency s most recent audit was completed/finalized/delivered If This is Greater than 6 Months from the End of Your Fiscal Year, Estimated Audit Completion Date Date on which you expect your agency s audit to be completed/finalized/delivered Example: Fiscal year ends June 30, 2014 and you do not have a 2014 audit; estimated completion date: April 1, 2015. 1/22/2015 2 UWP Letter of Intent Instructions
Name of Proposed Program or Service The name of the program or service for which funding is being requested. Remember, if requesting funding for more than one program/service, submit a separate Letter of Intent for each program/service. Impact Area (Please select only ONE.) Identify whether the program falls primarily into the Education, Health or Income impact area. Which Priority Level Do You Address? (Please select only ONE.) Identify which Priority Level the program addresses based on United Way of the Plains 2016 Funding Priorities. (Refer to Page 9, following.) Please Identify the Specific Need on the Funding Priority Grid. Utilizing the United Way of the Plains 2016 Funding Priorities, identify the need(s) your program most closely addresses and list in the space provided. Projected Number of Clients for This Program Indicate how many unique individuals will be served by this program during the year for which you are requesting funding. ( = unduplicated primary beneficiaries) Have You Received United Way Funding for this Program in 2015? Select either Yes or No. o If Yes, Are There Any Significant Program Changes Anticipated in 2016? Select either Yes or No. If you responded yes to the first question and no to the second question, then you are not required to fill out the second page of the Letter Of Intent. You will also only need to submit 1 copy of the Letter of Intent for this Program. Other program requirements as outlined at the bottom of page 2 of the Letter of Intent are still required. o If No, continue. PAGE 2 INSTRUCTIONS Briefly Describe the Need in the Community for the Program or Service Define the need in one or two short sentences. Use statistics, to assist in demonstrating the need. Brief Description of the Program or Service The first sentence should provide a one-sentence description of the program. Two or three simple, descriptive sentences may be added, but the first sentence should be able to stand on its own. Example: XXX helps children in low-income schools succeed academically through mentoring, after-school activities and counseling. Briefly Describe the Population Impacted by the Program or Service 1/22/2015 3 UWP Letter of Intent Instructions
Define the population you are serving as precisely as possible related to age, geography, finances, disabilities, race, ethnicity, etc. Try to limit to three to five key words. Examples: Low-income elementary children; frail senior citizens. Does Anyone Provide the Same or Similar Services? Select either Yes or No. If So, What Differentiates Your Program From Theirs? Demonstrate your familiarity with other organizations in the community doing similar work. Tell if other organizations serve a different target population. You do not have to be unique to receive funding. Describe the Desired Program Outcome(s) and How They Will be Measured Outcomes are benefits to or changes in the participants as a result of program activities; the results. (i.e., new knowledge, increased skills, changed attitudes or values, improved conditions) Describe the program s method of measuring changes in clients (outcomes) and if possible, the tool that will be used to measure that change Funding Request is for: Existing program has been in existence one or more years, whether receiving United Way funding or not Program expansion significant program expansion such as adding a new location for service provision New program program not previously in existence One-time startup -- program not previously in existence and expects to be selfsufficient in subsequent years Existing program with significant changes if selected, be sure to detail proposed program changes in the Brief Description of the Program or Service section. Anticipated Amount of Request for this Program Indicate the dollar range that corresponds to the expected program funding request. Anticipated Annual Total Program Costs Indicate the dollar range that corresponds to the program s total annual costs. Total Agency Budget Indicate the anticipated budget for your entire agency for the year for which you are requesting funding. How Will the Requested Funds be Used? (major expense categories) Tell why the program needs the money. (i.e., salaries, program supplies, insurance ) Keep it short and simple. Tie it to outcomes, beneficiaries, results, if possible 1/22/2015 4 UWP Letter of Intent Instructions
Any changes from previous year? How will changes affect outcomes or numbers served? Example: Hire a Spanish-speaking outreach worker to expand the number of Hispanics served. PLEASE ATTACH (One of each per agency): This is the agency information packet that consists of o A copy of your 501 (c) 3 or tax exempt certificate (Required) o A copy of your most recent audit unless United Way already has one (Required) o Agency board roster, including employer and mailing address (Required) 1/22/2015 5 UWP Letter of Intent Instructions
UNITED WAY OF THE PLAINS FUNDING ELIGIBILITY POLICY Approved by the Board of Directors November 15, 2012 I. MISSION STATEMENT The mission of United Way of the Plains, Inc. (UWP), is "to improve lives by mobilizing resources to meet community needs." II. GENERAL POLICIES UWP, within the limits of its financial ability, will consider applications for funding from all qualified non-profit organizations with programs meeting demonstrated health and human service needs located within and primarily serving people who live or work in Butler, Sedgwick, and Sumner counties (UWP service area). The purpose of this policy is to specifically outline criteria for funding eligibility. A qualified non-profit organization is one that meets the criteria listed below. A. LEGAL /REGULATORY 1. Is incorporated by the State of Kansas as a non-profit organization and has received tax exempt status under Section 501(c)3 of the Internal Revenue Service Code of 1986. 2. Provides programs in the areas of health, welfare, and social service delivery categories. 3. Is in good standing with the Kansas Secretary of State. 4. Has an Equal Employment Opportunity Statement. 5. Operates in compliance with all health, safety, and environmental laws, governmental ordinances, and codes for every facility. 6. Is in compliance with all applicable and material program licensing requirements. 7. Is in compliance with all applicable and material program accreditation bodies. 8. Has a written statement of purpose that clearly defines the agency s functions, organization, and lines of authority. 9. Complies with the restrictions on lobbying under the substantial part of activities test (IRS Code Sec. 501C) or the sliding scale limitation based on expenditures made to influence legislation (IRS Code Sec. 501H). 10. Complies with regulations and reporting requirements annually under the U. S. Internal Revenue Service and all applicable Kansas Department of Revenue regulation and state statutes. 11. Operates programs on a non-discriminatory basis without regard to differences in gender, age, race, color, creed, disability, religion and national origin. 1/22/2015 6 UWP Letter of Intent Instructions
B. GOVERNING BODY* *If the agency is the local arm of a statewide or national organization directed by a state or national governing board, or if it fulfills a specific mission of a local multimission organization directed by a governing board, the organization must have its own local active Advisory Board or Council. 1. Has an independent board of directors or trustees that meets at least quarterly and oversees the management of the agency and that comprises a minimum of ten (10) volunteer members, a majority of whom are not related to each other and none of whom are related to the agency s administrator (i.e., Executive Director) or senior staff. 2. Has adopted, and adheres to, written policies on board membership rotation, length of service, and conflict of interest. 3. Maintains written minutes for each Board meeting that documents attendance, deliberations, and decisions of the Board. 4. Has an administrator (paid staff or volunteer) who is responsible to the Board for the agency s administration and operations. If the administrator is a voting member of the Board, the administrator is subject to the conflict of interest policy. 5. Operate programs on a non-discriminatory basis without regard to differences in gender, age, race, color, creed, disability, religion and national origin, C. FINANCIAL/FISCAL MANAGEMENT 1. Documents and follows internal policies and procedures for fiscal control. 2. Has an annual independent audit performed and financial statements prepared in accordance with United Way of the Plains Policy on Agency Audits and Management Letters. 3. Is able to demonstrate compliance with reporting and other requirements of local, state, and federal legislation including, but not limited to, the filing of annual reports with the IRS on Form 990. 4. Is current with past and present IRS obligations. 5. Utilizes a financial accounting system that facilitates the preparation of yearend financial statements conforming with accounting principles and audit standards generally accepted in the United States of America. D. ORGANIZATIONAL PLANNING AND DECISION MAKING 1. Has documented goals; measurable and attainable service outcomes; a reasonable plan for specific tasks and activities; indicator(s)/measure(s) for achieving objectives; and methods of evaluating outcomes. 2. Maintains an unduplicated count of clients served and participates in annual beneficiary and employer statistics gathering. 3. Has a mechanism in place to gather client input. 4. In general, has operated continuously and provided services for a minimum of two years prior to the fiscal year of application for funding, otherwise additional information may be required to determine a reasonable degree of continuity and community support. 5. Demonstrates effectiveness in program performance and accountability. 1/22/2015 7 UWP Letter of Intent Instructions
E. PROGRAM 1. Avoids religious proselytizing in its human service programs and agrees to not use funds received from UWP either directly or indirectly for religious activities. 2. Provides local professional staff, officed in the UWP service area and regularly available for contact during normal working hours. 3. Provides services to those who live or work in the UWP service area. 4. Provides a local telephone number, which is publicly advertised throughout the year and available to citizens of the area. This may not just be a 1-800 or 1-888 number. III. ADDITIONAL CONSIDERATIONS: If an agency decides to apply for UWP program funding, the agency as a whole must abide by UWP criteria and policies. Agencies receiving funding from UWP will acknowledge UWP support in their public relations materials (e.g., letterhead, annual reports, PSA s, brochures, special events, etc.), and display the UWP logo at those physical facilities that house UWP-supported programs. All new program funding requests will be evaluated in relationship to Level I and II needs identified in the latest UWP Priority Study. 1/22/2015 8 UWP Letter of Intent Instructions
Level 1 Level 2 Basic medical care for low-income Before and/or after school services Child day care Counseling/mental health services (children/youth/adults/families/seniors) Early care and education for children Emergency shelter (children/youth) Food assistance Job training/retraining assistance Juvenile delinquency/gang prevention Mentoring for children/youth at risk of failure Parenting education Preparing young people for the workforce Safe, affordable, accessible housing Tutoring for children/youth at risk of failure Youth development/character building Assistance with prescriptions for low-income Child abuse prevention and education Disaster response for fires Drug/alcohol abuse prevention and education Emergency financial assistance (mortgage/rent, utility bills) Employment assistance services: adults/seniors Financial and credit counseling Home health care: homebound seniors/disabled Home health care: homebound seniors/disabled Home repair and safety for seniors Homemaker services: seniors/disabled Meal delivery for homebound seniors/disabled Specialized transportation (seniors/disabled) Level 3 Level 4 Adult basic education (job skills, computers) Adult literacy programs Adult day care services, incl. respite care Assistance/services to victims of crime Assistance to victims of disasters Counseling for victims of sexual assault Assistance/services for victims of domestic violence Emergency notification: serviceperson s family Assistance: offenders reintegrate in comm. Environmental pollution and recycling Current/correct info about available services Gambling addiction prevention and education Day care services for the mentally ill Health insurance (moved from 1 to 4) Emergency shelter for homeless adults House construction/repair for low-income Employment assistance/services: disabled Housing counseling Family violence prevention Legal aid Health care education programs Medical research (i.e., heart, cancer) Learning experiences for disabled children National advocacy for medical programs Living facilities for children and youth Pandemic flu prevention Recreational programs: children/youth/adults Sexual assault prevention and education Resources for caregivers/respite care Sheltered workshops for disabled Treatment for drug/alcohol abuse Treatment for life-threatening diseases (cancer, congestive heart failure) (moved from 2 to 4) Volunteer opportunities in the community 1/22/2015 9 UWP Letter of Intent Instructions
1/22/2015 10 UWP Letter of Intent Instructions