This form is intended to help United Way learn about your organization. This is not a program application. We are interested in an overview of your organization and how it aligns with our goals. The application will ask you to review United Way’s goals and tell us what kinds of outcomes you track that are aligned with those goals.


The forms submitted here are reviewed quarterly. Therefore, within a few months you can expect to hear from a United Way representative with suggestions for next steps. We ask that you not submit multiple forms per year.

* 1. Agency Information

* 2. Please list the communities (or regions) in which your agency provides services:

* 3. What is your agency’s mission statement?

Please carefully review United Way’s goals in Financial Opportunity and Educational Success.

In the following response boxes, briefly describe how your organization’s programs and services and/or public policy work aligns with these goals. Include an executive summary of the outcomes you track.

* 4. Alignment to Financial Opportunity

* 5. Summary of outcomes tracked aligned with United Way's goals for Financial Opportunity

* 6. Alignment to Educational Success

* 7. Summary of outcomes tracked aligned with United Way's goals for Educational Success

* 8. Does your agency currently receive grant support from United Way?

* 9. If yes, what work is your agency’s current grant supporting?

* 10. Has your agency received grant support from United Way in the past?

* 11. If yes, what grant(s) did you receive from United Way?

Please click the "Done" button below to submit your request.

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