Starke United - Our Support

Starke United & You...Doing What Matters!

Agency Funding Request

Are you an agency seeking funds for a community outreach program? Our Resource Deployment Committee will review your request and award funds on a annual basis based upon community needs. Simply complete this form and we'll consider you for funding.

Please note: the next funding cycle is scheduled for April, 2007.

Date:
Organization Name:
Address:
Address (Cont.):
City:
State:		Zip Code:
Telephone:
Contact Person:
Contact Person's Title:

Please choose one:

		We are a 501(c)(3) agency and our information is already on file in the Starke United office.
		We are a 501(c)(3) agency and a copy of our IRS verification letter will be sent upon request.
		We are a non-profit agency without a 501(c)(3) status and a "Verification of Use" form will be sent upon request.

Amount of undesignated funds requested: (You must fill in a dollar amount, do not leave blank.)

PLEASE NOTE: Funds awarded are paid out on a quarterly basis. If the funds you are requesting are needed in one sum, please submit justification with a nartative, below:

Project for which funds are being requested:

Is this project: A New Project A Continuing Project

Have you received undesigned funds from Starke United in prior years? Yes No

If yes, List years: *

*If you received funds in 2006, please be sure to complete Program/Project Funded in 2006 section.

Have you received funds from Starke United for this project in prior years? Yes No

If yes, List years:

Is this project totally dependent upon the granting of Starke United funds? Yes No

If no, please explain:

In which of the following areas of concern will your project serve Starke County?

Community Improvement:
  Youth Recreation
  Community Recreation
  Cultural Activity

Family Issues:
Literacy
Child or Domestic Abuse
Teenage Pregnancy
  Lack of Parenting Skills
  Day Care
  Elderly
  Services for Disabled

Substance Abuse:
  Drug & or Alcohol Abuse
  Tobacco Use

Emergency Services:
  Food Pantry
  Utility Bills Assistance
  Fire Relief Assistance
  Housing

Description of the project:

Explain how this project fits into area(s) of concern already identified:

Explain how this project will specifically benefit Starke County residents:

Goals for the project:

Expected outcomes:

Complete this section ONLY if you received undesignated funds for any project in 2006.

Program/Project Funded in 2006

Do you feel that you had success with program funded with Starke United funds last year?
Yes No

How do you measure that success?

What would you do differently with this program if it did not meet your expectations?

Will you continue with this program? Yes No

Will you continue with this program even if you do not receive further funding from Starke United?
Yes No

Did you spend all of the undesignated funds you received through this grant? Yes No

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