2019 Agency Feedback FormRating Scale: 80 total points possible0 = Not demonstrated, 1 = Poor, 2 = Average, 3 = Good, 4 = Excellent Agency Name * Program * The management/supervisory structure is appropriate for the program * Agency incorporates diversity in staff, volunteers and client base * Agency is in good financial standing and providing monthly reports to UWCL * Agency secures funds or resources outside of United Way of Central Louisiana * United Way fund request does not exceed 50% of program budget * Application provides a thorough rational for dollars requested * Please Total Score Part A * Program aligns with one or more of UW impact areas and goals * Target population is clearly defined * There is documented need for the program services * Client outcomes are collected and measured effectively * Program is effective in helping clients achieve desired outcomes * Board is actively involved and monitors program effectiveness and stability * The need for UW support to deliver the desired results is demonstrated * Program outcomes are realistic and achievable within the timeframe specified * Please Total Score Part B * Agency visit was well-organized; presenter were prepared * Visit included active participation by Board member(s) * The facilities and equipment adequately serve program needs * Agency offices and materials display the UWCL logo prominently * Questions were answered completely; either at the initial Agency Visit or on individual follow-up visits * Please Total Score Part C * Agency participates in UWCL campaign and fulfills pledge * Total Score for Program * Notes/Comments: Your Name * Submit