Grant Application

Agency Information
Program Summary

Which of the UWCL impact goals does your agency's program support?
What parishes will this program serve? Select all that apply.
Are any major changes contemplated for the program in the coming year?
Outcome Measurement Form

Example Outcome Measurement Form:

Program Information
Impact Area
Outcome Data
Be specific: how many dollars, how many volunteers, etc. are needed to conduct the program activities.
What are the activities that your agency implements in order to help its clients?
How many of the activities did your agency conduct last year? Examples: include # or % of clients served, # of classes held, etc.
Outcome # 1
What is your agency trying to help your clients achieve?
What is being measured to indicate a level of success?
Usually expressed as a # or %, these can be short-term or long-term
Was there an attempt to reach a certain level of achievement?
Provide the time period of data collection and the data for each indicator. 
Outcome # 2
What is your agency trying to help your clients achieve?
What is being measured to indicate a level of success?
Usually expressed as a # or %, these can be short-term or long-term
Was there an attempt to reach a certain level of achievement?
Provide the time period of data collection and the data for each indicator. 
Outcome # 3
What is your agency trying to help your clients achieve?
What is being measured to indicate a level of success?
Usually expressed as a # or %, these can be short-term or long-term
Was there an attempt to reach a certain level of achievement?
Provide the time period of data collection and the data for each indicator. 
Agency Staff Information
Have funding cuts led to a reduction in staff this year?
What is the ethnic composition of your regular(not seasonal) staff? Information on the number of minorities involved in United Way can be helpful in ensuring diversity and inclusion.
Supporting Documentation
Please include name, place of employment, address and phone number. If this roster does not identify board officers, please attached a list of the officers of your board as well.
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Attach IRS 990 Form for the last fiscal year.
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