Grant Application Request Form

We appreciate your desire to receive funding and partner with United Way of Southeast Missouri. Please complete this preliminary questionnaire to receive a unique link to your grant application. If you desire funding for more than one program, you must complete and submit a separate questionnaire for each program. If you are not emailed an application link within 3 business days of completing this form, email Donna.Noe@unitedwayofsemo.org.

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* 1. Name of organization

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* 2. Name of program if applicable

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* 3. Is organization/program a 501(c)3?

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* 4. My organization/program serves the following counties (check all that apply):

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* 5. My organization/program supports United Way's focus on (check all that apply):

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* 6. I am a previous UWSEMO Funded Partner

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* 7. Brief description of program (no more than two sentences).

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* 8. Years program has been in operation:

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* 9. Program or agency URL (website):

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* 10. Program or agency physical address:

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* 11. IRS Employee Identification Number (EIN) if applicable; if not, leave blank.

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* 12. Does your program/agency have a board of directors?

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* 13. Your name:

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* 14. Your title:

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* 15. Your email address:

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* 16. Your phone number:

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