Valley United Way Youth Leadership Program

Valley United Way’s Youth Leadership

Venture Funding Program

Request Form

You may either print this form and submit it by mail, or complete it on-line an hit the submit button to send it directly. The deadline is February 1, 2012. Programs must be deal with one of the following issues: texting and driving, bullying, dating violence, drugs, underage drinking, stress, arts, recycling, mentoring and after school activities.

Name of program for which funding is being requested:

Applying organization and address:

Phone:  Fax:

Agency Director:

Program Contact Person:

Contact e-mail:

Does your organization hold not-for-profit corporate status? (i.e. social service agency, school, municipality, church):   Yes   No

Total Program Cost:

Amount of funding requested from Youth Leadership:

Program time-frame (From/to):

Estimated number of persons to benefit from program:

Program Information

Briefly describe the program/service for which funding is requested.

How was the need for the proposed program/service determined?

Describe how the proposed program/service will impact the need identified above.

What are the primary objectives of the proposed program/service?

How will you evaluate the proposed program/service?

How will this program/service be supervised by the organization?

Provide an itemized income and expense budget for the proposed program/service. Use this space or e-mail to volunteer@valleyunitedway.org.

 

Indicate donated resources which the program/service will utilize (i.e. use of space, postage, telephone.) Identify what linkages this program will develop with other organizations and community resources.

 

If you have questions about the Youth Leadership Program call Valley United Way at 203-926-9478 or e-mail at volunteer@valleyunitedway.org.