2026 GRANT APPLICATION - United Way of Wyoming County

Grant Application
2026

Please enable JavaScript in your browser to complete this form.

1Agency

2Mission

3Program(s)

4Funding

5Expenses

6Narrative

7Inputs

8Outcomes

9Stories

10Uploads

11Leadership

Agency Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Agency Website / URL

Your Name *

Person Submitting Application

Your Title *

Your E-Mail *

Submitter E-Mail

Your Phone *

If we have questions about the application.

Save and Resume Later

Agency Mission Statement *

What is the Mission of your agency?

Agency Description (Programs & Target Populations) *

Provide a description of your agency including your current programs and target populations served.

Save and Resume Later

Program Funding Requests

You may submit funding requests for up to 3 programs under your agency.

For each program, provide the name, description, and requested grant amount.

If you only have one program, simply fill out the first 3 rows.

Program Name #1 *

Program Description #1 *

Grant Amount Requested (Program #1) *

Enter whole numbers only (no cents, no commas)

Leave #2 and #3 Blank if Only Applying for ONE (1) Program

Program Name #2

Leave Blank if Only Applying for ONE program

Program Description #2

Leave Blank if Only Applying for ONE program

Grant Amount Requested (Program #2)

LEAVE BLANK IF ONLY ONE PROGRAM
Enter whole numbers only (no cents, no commas)

Program Name #3

Leave Blank if Only Applying for ONE program

Program Description #3

Leave Blank if Only Applying for ONE program

Grant Amount Requested (Program #3)

LEAVE BLANK IF ONLY ONE PROGRAM
Enter whole numbers only (no cents, no commas)

TOTAL REQUEST FOR FUNDING

This is the combined total of all program(s) grant requests above.

Total Request for Funding (All Programs)

Sum of all program grant amounts. If this field is blank, your web browser may be blocking Javascript - enter manually if needed.

Wyoming County Service Area? *

Do you currently serve Wyoming County clients? If yes, please describe current client base and/or outreach methods. If no, please explain how you plan to serve Wyoming County clients.

Save and Resume Later

AGENCY SOURCES OF FUNDING

Please enter all entries with whole numbers. Rounded. No cents.

We will display the field entries just below the field with $XX,XXX for confirmation.

AGENCY SOURCES OF FUNDING

If ZERO Enter "0"....If None, Enter something ". - or n/a" in Description

Other United Ways *

Description (Other UW) *

Other United Ways

Contributions *

Description (Contributions) *

Contributions

Special Events/Fundraising *

Description (Special) *

Special Events/Fundraising

Government Funding *

Description (Gov) *

Government Funding

Other 1 (Specify - i.e. user fees)

Description (Other 1)

Other (Specify - i.e. user fees)

Other 2 (Specify)

Description (Other 2)

Other 2 (Specify)

Other 3 (Specify)

Description (Other 3)

Other 3 (Specify)

TOTAL SOURCES OF FUNDING

Formula: (Total UW Request + Other Sources of Funding)

Total Sources of Funding

If this field is blank, your web browser is blocking Javascript.

AUTO-MATH TIPS

This math is being done in real time. If it doesn't auto-update, try clearing the field, selecting and hitting the spacebar. Hitting TAB to the next field. This may trigger an auto calculate function. If this field is blank, your web browser is blocking Javascript. No worries though, we have the data recorded!

Save and Resume Later

Total Program(s) Budget (Current Fiscal Year) *

Round Numbers Only, No Cents, No Commas

PROGRAM EXPENSES

If ZERO Enter "0"....If None, Enter something ". - or n/a" in Description

Administrative Salaries *

Staff

Description (Admin Salaries) *

Administrative Salaries

Personnel Salaries *

Paid Part-Time Help, etc.

Description (Salaries) *

Personnel Salaries

Occupancy Expenses *

Rent/Lease + Electric + Internet, etc.

Description (Ocu Exp) *

Occupancy Expenses

Payments to Affiliated Organizations *

Membership Fees, etc.

Description (Afil Org) *

Payments to Affiliated Organizations

Other (i.e. admin cost)

non-personnel

Description (Admin Costs)

Other (Specify - i.e. non-personnel admin cost)

Other (i.e. Program costs) *

non-personnel

Description (Pgm Costs)

Other (Specify i.e. non-personnel program costs)

Total Program Expenses

If this field is blank, your web browser is blocking Javascript.

PROGRAM(S) IMPACT

# of Clients Served Yearly *

Number of Clients Served (Estimated)

Spending Per Client $

If this field is blank, your web browser is blocking Javascript.

How much is spent per client?

Formula: Budget ÷ Clients Example: $50,000 ÷ 1000 = $50

AUTO-MATH TIPS

This math is being done in real time. If it doesn't auto-update, try clearing the field, selecting and hitting the spacebar. Hitting TAB to the next field. This may trigger an auto calculate function. If this field is blank, your web browser is blocking Javascript. No worries though, we have the data recorded!

Save and Resume Later

BUDGET NARRATIVE *

Please provide a brief narrative that explains how you will be using the Wyoming County United Way funding

Costs) of (Contributions)

Save and Resume Later

COMMUNITY IMPACT (Inputs)

How the program changed the participants' skills, knowledge, behavior, condition, attitude, or value.

Outcome #1 Inputs *

Resources a program uses to achieve program objectives.

Activities *

What a program does with its inputs - the services it provides - to fulfill its mission.

Outputs *

Direct result of a program's activities. (projected)

Outcome #2 Inputs *

Examples: staff, volunteers, facilities, equipment, curricula, supplies.

Enter Activities For Outcome #2 *

Examples: sheltering homeless families, counseling for at-risk youth, educating public on signs of child abuse.

Enter Outputs For Outcome #2 *

Examples: numbers of meals provided, classes taught, brochures distributed, participants served.

Save and Resume Later

COMMUNITY IMPACT (Outcomes)

How the program changed the participants' skills, knowledge, behavior, condition, attitude, or value.

Outcomes *

How the program changed the participants' skills, knowledge, behavior, condition, attitude, or value. (projected)

Indicators and Data Source *

Indicators and Data Source The number and percent of program participants who demonstrate the listed outcomes and the data source to be used for each. (projected)

Outcomes #2 *

Examples: greater knowledge of nutritional needs, improved reading skills, effective response to conflict, getting a job, having greater financial stability

Indicators and Data for Outcome #2 *

Example: 25% (or 25) of the 100 participants have a greater knowledge of nutritional needs, based on a survey conducted at the end of the program.

Save and Resume Later

Success Stories

Can Wyoming County United Way use this story for marketing purposes?

Should the United Way keep client anonymous?

Save and Resume Later

Please Include These Attachments:

List of your Board of Directors
Organizational Chart
IRS Determination Letter
Certificate of Registration
Audit
990
Annual Report

If you need to upload more, or forget to add a form, please Email khuff@wyomingcountyunitedway.org.

Supporting Documents

Drag & Drop Files, Choose Files to Upload You can upload up to 50 files.

If You Need To Upload More, Please Email khuff@wyomingcountyunitedway.org ATTACHMENTS ARE *NOT* SAVED to the Applications "SAVE AND RESUME" Process for Security Reasons. You will have to RE-ATTACH to each submission.

Save and Resume Later

Agency Leadership Information

Please provide contact information for your Board Chair and Chief Executive Officer.

Board Chair Name *

Board Chair E-mail Address *

Board Chair Phone Number

Chief Executive Officer Name *

Chief Executive Officer E-mail Address *

Additional Comments

Your Signature *

Clear Signature

I understand this request has been prepared for the Wyoming County United Way. It fairly and accurately represents the mission of our agency and the needs of residents in Wyoming County. We understand this request will be considered with all requests for funding, and if funded, we agree to abide by all United Way policies.

Save and Resume Later

Heads up! Saving your progress now will store a copy of your entry on this server and the site owner may have access to it. For security reasons, sensitive information such as credit cards and mailing addresses, along with file uploads will have to be re-entered when you resume.

This is NOT a perfect system, so you should try and keep a local copy of all your work.

Go Back

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

Email *

Powered by AI Programming by MoodUS Media ® LLC
Tim Edwin Robinson - tim@moodUSMedia.com - 570-500-0212

Grant Application 2026

Program Funding Requests

Leave #2 and #3 Blank if Only Applying for ONE (1) Program

TOTAL REQUEST FOR FUNDING

AGENCY SOURCES OF FUNDING

AGENCY SOURCES OF FUNDING

TOTAL SOURCES OF FUNDING

AUTO-MATH TIPS

PROGRAM EXPENSES

PROGRAM(S) IMPACT

How much is spent per client?

AUTO-MATH TIPS

COMMUNITY IMPACT (Inputs)

COMMUNITY IMPACT (Outcomes)

Please Include These Attachments:

Agency Leadership Information

Grant Application
2026