The United Way of Sarnia-Lambton -


			July 31, 2010

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Online Venture Grant Application Form

Dear Applicant,

Thank you for your interest in the United Way of Sarnia-Lambton's Venture Grant Program.

The Venture Grant Program is open to community groups whose services fit within some
or all of the United Way Funding Priorities:

For an up to date listing of the Funding Priorities of the United Way of
Sarnia-Lambton, please review the Long Range Plan located on this website.

For further information on the Venture Grant Fund or Program Outcomes, please surf the
United Way's website for more details.

Venture Grant Application

	AGENCY:
	PROGRAM NAME:
	COMPLETED BY:
	E-MAIL ADDRESS:
	TELEPHONE:

Does your organization have a BN (Charity Registration Number)?

	No	Yes

NOTE: Should you have any questions, please do not hesitate to e-mail Pamela Bodkin, Community Investment & Finance Director at pam@theunitedway.on.ca

1) STATEMENT OF SPECIFIC COMMUNITY NEED

Describe the program you would like funded. Describe what problem/need exists in the community and who is the target client population, where do they live, including estimated numbers in need, and any information or statistics that indicates that this is a need. (Please include sources of information and statistics)



2) PROGRAM OUTCOME GOALS

What are your program outcome goals? In other words, identify the intended effect of the program on the need. What are you trying to accomplish?

	3) PROGRAM OUTCOME OBJECTIVES

	Objectives further define the program goals by describing the effect on the client the program is trying to produce. Describe your Program Outcome Objectives. What measurable effects or competencies do you expect clients of this program to achieve during this funding cycle? (An objective is expressed as a number and/or percent of participants achieving the Outcome and must include a timeframe.)

4) COMMUNITY INVOLVEMENT

How will you involve the people expected to benefit from your project in the development of the Project?



5) PROGRAM OUTCOME MEASURES

What two (2) measurements/indicators do you plan to use to assess the outcome of your project? This can include: case studies, checklists, focus groups, interviews, observations, questionnaires/surveys etc.



6) PROGRAM SERVICES

Services describe the actions you will take, techniques you will use, or procedures you will follow to bring about the change. What services do you plan to provide in order to achieve your Program Outcome Objectives?



Will you offer these Services throughout the year?

	Yes	No

7) PROGRAM PARTICIPATION

What is the total number of people projected to be served?



8) COMMUNITY RESPONSIVENESS

Describe other community services that address the same community need. What differentiates your services?



9) PROGRAM OUTCOME/IMPACTS

How will the clients benefit from having this program in place? What change will occur to help solve community problems? How will you know that you were successful? What difference will this program make to the client and the community?



10) ROLE / IMPORTANCE OF UNITED WAY FUNDING

How important is the United Way to you and your program? What role will United Way funding play in meeting the identified need?



11) SUSTAINABILITY

How will you sustain this project once the United Way grant ends?


12) REVENUE AND EXPENDITURE SUMMARY

PROJECTED REVENUES		Year 1

Venture Grant Fund Request
Other Sources

TOTAL REVENUES	$

PROJECTED EXPENDITURES		Year 1





TOTAL EXPENDITURES	$

SURPLUS OR (DEFICIT)	$

NOTES:


	You will receive a copy of the completed form by email. Please note that each field must be complete or your submission will not be accepted.

	Please enter the text in the image below:

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