City of Terre Haute and United Way
Nonprofit Grant Program
Project Qualification Survey

Thank you for your interest in the Nonprofit Grant Program.

As the first step, each applicant will complete a Project Qualification Survey outlining their basic funding request and organization’s basics and provide Stewardship Package documents.

Review of these documents will determine whether an organization is eligible to apply for funding. The answers to these questions will not be evaluated based on their response, but rather to ensure that answers align with the goals of the funding and that the organization qualifies to fully apply. This will help potential applicants avoid developing lengthy proposals which are not competitive. Deadline for entry is May 30, 2024 at 5:00 pm.

If the Project Qualification Survey doesn’t align with eligible funding opportunities, varies significantly from the grant purpose and outcomes, or if any of the requested Stewardship Package documents are not available and submitted, the applying organization will not be allowed to submit a full application and will be removed from the process and notified of the decision.

If you have questions please reach out to the United Way of the Wabash Valley office at 812-235-6287 or info@uwwv.org.

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* Name of organization

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* Address of organization

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* Point of contact for funding:

Name

Title

Phone Number

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* Date the organization began operation (month/year)

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* Are you a 501(c)(3) or 501(c)(19) organization?

Yes

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* Provide a short introduction to the organization and its overall goals for the community.

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* Amount of funding requested - The funding amount requested is not binding and can be adjusted if the organization is selected for a full application. If there is an adjustment in funding amount the applicant will be asked to provide an explanation of the need to change the requested amount.

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* Provide a general breakdown of the intended use of the requested funds.

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* Is this funding request part of a larger project? If so, what is the overall project budget? Please highlight any additional outside grant funding being utilized.

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* Please indicate which of the below goals this funding will help your organization achieve.
(Please select all that apply)

Build capacity and organizational development of nonprofit community.

Strengthen organization’s infrastructure, management, and/or governance.

Increase organizational effectiveness.

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* How will this funding help your organization achieve the above goal(s)? For each response, please include which goal(s) you are working toward and provide the projected outcome that will result from the funding.

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* Is your organization facing any pending litigation or legal action?

Yes

If yes, please explain.

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* Has your organization been debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs?

Yes

* Name of organization

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* Address of organization

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* Point of contact for funding:

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* Date the organization began operation (month/year)

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* Are you a 501(c)(3) or 501(c)(19) organization?

Question Title

* Provide a short introduction to the organization and its overall goals for the community.

Question Title

* Amount of funding requested - The funding amount requested is not binding and can be adjusted if the organization is selected for a full application. If there is an adjustment in funding amount the applicant will be asked to provide an explanation of the need to change the requested amount.

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* Provide a general breakdown of the intended use of the requested funds.

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* Is this funding request part of a larger project? If so, what is the overall project budget? Please highlight any additional outside grant funding being utilized.

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* Please indicate which of the below goals this funding will help your organization achieve. (Please select all that apply)

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* How will this funding help your organization achieve the above goal(s)? For each response, please include which goal(s) you are working toward and provide the projected outcome that will result from the funding.

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* Is your organization facing any pending litigation or legal action?

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* Has your organization been debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs?

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* Current fiscal year organizational budget for the applying organization.

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* Board of Directors roster

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* Minutes of a recent board meeting

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* Proof of financial oversight. May include audited financial statements or signed letter from accountant.

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* IRS determination letter

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* Last two years of IRS 990 filings (cover page only) or if unavailable, last two year-end financial statements (including balance sheet and income statement).

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* Additional uploaded files, if necessary.

City of Terre Haute and United Way
Nonprofit Grant Program
Project Qualification Survey

* Please indicate which of the below goals this funding will help your organization achieve.
(Please select all that apply)