Download 2016-2017 Letter of Intent Application Document

Letter of Intent Cover Page
2016-2017 Community Investment Grants
Complete the required LOI documents and then combine into one(1) .pdf file. E-mail to LeAnn Powers
([email protected]) before 5:00 p.m., Thursday, January 21, 2016.
Note: ONLY electronic submissions will be accepted. The time of submission is the date & time indicated in the
Inbox of LeAnn Powers, not the Sent time of the Sender. Late or incomplete submissions will not be accepted.
Agency Name
Agency Website
Agency EIN
Agency Mailing Address (City, State, Zip)
Agency Street Address (City, State, Zip)
Agency Phone
Agency Director ED/CEO
Agency Director Phone
Agency Director Email
Agency’s Primary Contact for
Application
Title of Primary Contact
Primary Contact Mailing Address (City,
State, Zip)
Primary Contact Street Address (City,
State, Zip)
Primary Contact Phone
Primary Contact Email
Agency Board Chair
Agency Board Chair Phone
Agency Board Chair Email
Project/program name:
Amount of funding requested: Minimum
request of $10,000, increased increments thereafter
of $5,000 and not to exceed $40,000.
$________________________________
United Way of Williamson County Community Investment Grant Letter of Intent
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Letter of Intent Outcome Checklist
Please check the box of at least ONE United Way of Williamson County Outcome to which
your program aligns. Important Note: You can certainly choose more than one, but if you receive a grant
from United Way of Williamson County, you will be required to report on at least ONE of the Indicators listed within
each/all of the Outcomes you have selected. Please plan accordingly.
Focus Area
Education
Goal
Goal: Increase
percentage of
children who enter
school (kindergarten)
ready to learn.
Outcome
 Parents/guardians/care givers use acquired knowledge to
improve their child’s academic preparedness.
Indicators:
1. Number of parents/caregivers receiving training and
information
2. Number of parents/caregivers indicating an increase in
knowledge about improving their child(ren)’s language
and literacy skills.
 Children enter school with the necessary foundational
skills needed to begin pre-kindergarten and kindergarten
learning.
Indicators:
1.
Number of parents that indicate they regularly read to
their child(ren).
2. Number of pre‐k and kindergarten teachers that
indicate the child(ren) in the reading programs are ready
for kindergarten.
Goal: Increase the
percentage of young
people graduating
from high school on
time.
 Youth will have improved self-esteem, better classroom
behavior, reduced truancy and increased interest in school.
Indicators:
1. Number of volunteer mentor/mentee matches.
2. Number of youth with improved attendance.
3. Number of youth with better classroom behavior.
 Youth demonstrate improved school academic
performance in one or more core subjects.
Indicators:
1. Number of tutors and number of tutored students.
2. Number of youth that improve their grades in one or
more cores subjects.
 The family/ caregiver of at-risk youth will be more
involved in their child’s learning and development.
Indicators:
1. Number of families/caregivers attending programs on
life skills, life management and family engagement.
2. Number of families/caregivers that report they have
increased knowledge & skills in order to support their
child(ren)’s academic success
United Way of Williamson County Community Investment Grant Letter of Intent
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Focus Area
Health
Goal
Goal: Increase
access to prevention
programs
Outcome
 Individuals use their acquired knowledge to better
manage their chronic disease.
Indicators:
1. Number of people attending workshops focused on
Chronic Disease Management.
2. Percent decrease in clinical markers of people
attending workshops.
3. Number of people that indicate they have improved
their knowledge about their Chronic Disease.
4. Number of people indicating they can better manage
their disease as a result of participating in an
education and/or prevention program.
 Children and adults that have been affected by physical,
sexual or domestic abuse/violence will feel safe and be able
to rebuild their lives.
Indicators:
1. Number of clients/families who report that they can
now make an informed choice regarding their safety
2. Number of children reported to have an improvement
in trauma-related symptoms.
 Seniors with limited resources will feel less isolated,
maintain good health and continue to live in their own home
or that of a family member.
Indicators:
1. Number of seniors receiving nutritious meals once a
day.
2. Number of seniors receiving transportation to the
doctor or grocery store.
3. Number of seniors (or their caregivers) reporting the
ability to live in their home and avoid assisted living.
Goal: Increase
access to quality
primary care
(prenatal through
adult)

Uninsured Williamson County residents will have access
to a medical home and will not need to use the Emergency
Room for non-emergency medical care.
Indicators:
1. Number of people assisted with enrollment in the
Health Insurance Marketplace
2. Number of people counseled regarding the Health
Insurance Marketplace.
3. Number of new/unduplicated individuals connected to
a medical home
4. Percent of patients that report avoiding the Emergency
Room visit due to access to healthcare.
United Way of Williamson County Community Investment Grant Letter of Intent
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Focus Area
Income/
Financial
Stability
Goal
Goal: Increase
income, assets and
job training for
improved
employability.
Outcome
 Individuals use their acquired knowledge to improve their
financial stability.
Indicators:
1. Number of individuals attending financial literacy
classes.
2. Number of individuals that report that they have
improved their financial ability to meet their basic
needs.
3. Number of individuals that report they have increased
their financial knowledge on how to properly handle
debt, budgets, savings & credit.
 Individuals utilize their training, support, education and
credentials to obtain a position in a field that provides a
sustainable wage.
Indicators:
1. Number of individuals receiving training, support,
education and credentials in programs that enhance
employability.
2. Number of individuals obtaining a position in a field
that provides a sustainable wage.
 Individuals make sound financial decisions that result in
increased savings and assets.
Indicators:
1. Number of federal tax returns completed.
2. Number of individuals who claim the Earned Income
Tax Credit.
3. Number of individuals participating in a matched
savings program.
4. Number of individuals attending self-employed
coaching classes.
Focus Area
Basic Needs
Goal
Goal: Address
nutrition, utilities and
housing needs
across the county.
Outcome
 Individuals and families in crisis will have their immediate
basic needs met.
Indicators:
1. Number of individuals and families receiving free,
balanced, nutritional food
2. Number of individuals and families who avoid eviction
or utility disconnection
United Way of Williamson County Community Investment Grant Letter of Intent
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Letter of Intent Outline
2016-2017 Community Investment Grant
Complete the following outline to describe the program/project for which you are applying for a
United Way of Williamson County Community Investment Grant. Expand each section as needed
but do not exceed four pages (The 4-page limit DOES NOT include the Cover Page, Outcomes
Checklist or Checklist/Signature page). If applying for more than one project/program, a separate
LOI outline must be submitted for each.
Organization _________________________________________________________
I.
Brief description of the organization with mission statement.
Include all of your current programs and provide statistical and demographic information on those being
served by these programs (be sure these statistics indicate those being served in Williamson County). Limit
to two paragraphs and/or approximately 250 words.
II. Proposed project/program name________________________________________
Amount of funding requested___________________________________________
Describe your project/program
This section should include, but is not limited to, targeted population, project/program methods of
implementation, staff and/or volunteer resources, project/program location(s), project/program length.
III. Will this program/project be part of a collaborative or partnership effort within the
community?
Please include a listing of all agencies, businesses, schools, government entities and others, as well as a
description of how these collaborations work together to assist in the success of this project/program.
IV. Description of need in Williamson County as it relates to your LOI project/program
request.
Limit to two or three paragraphs. Be sure to include statistical information supporting the need specific to
Williamson County and site references used. Also be sure to include information on how your organization
is working to meet this need and how many you currently, or will, serve.
V. Describe your organization’s strengths and ability to deliver the project/program.
VI. Description of the continuation plan for this project/program.
United Way of Williamson County Community Investment Grant Letter of Intent
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VII. Please restate the Focus Area, Goal & Outcome you chose from the Outcome
Checklist:
Focus area
Goal
Outcome(s)
Describe in detail how your project/program will help achieve the above
Goal/Outcome that you chose from the Outcome Checklist. (If you checked off more
than one Outcome, then copy and paste the above chart and description space as needed.)
Please be sure that the information listed here is specific, measurable, attainable, realistic, time-sensitive.
Short-term and long-term community impacts of the project/program should also be included. Please include
how the project/program outcomes will be measured and evaluated, as well as the methods or tools used in
this process.
VIII. Estimated numbers to be served/impacted by the project/program in Williamson
County.
Please be specific as to how many and in what parts of the County (cities/regions/areas) this program will
reach/serve.
IX. A brief budget outline indicating cost for services (a full one-page project/program
budget should be attached separately) and include how the UWWC grant
funding would be used.
Specifically include the per person cost of service for this project/program.
X. Project/program timeline.
United Way of Williamson County Community Investment Grant Letter of Intent
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Letter of Intent Checklist/Signature Page
2016-2017 Community Investment Grant
1. Please print out this page.
2. Check off the items listed below to indicate that they are included in your LOI Application
Packet.
3. ED/CEO must sign.
4. Scan this completed Checklist & Signature Page and include it at the end of your LOI
Application Packet.
 Completed Cover Page.
 Completed Outcome Checklist.
 Completed Letter of Intent Outline using the outline provided in this Application Packet (no
more than 4 pages when expanded).
 Included a one page project/program budget that shows all funding sources and expenditures.
 Included a copy of the organization’s IRS 501(c)(3) Letter of Tax Exempt Status.
 Included a current list of the Board of Directors with addresses.
 Included a list of the Board of Directors 2016-2017 meeting schedule.
 Completed the Checklist & Signature page and included it in the LOI Application Packet.
 Converted all of the above into one(1) .pdf file.
 Did not include additional items, marketing materials, newspaper articles, etc.
 E-mailed the completed LOI Application Packet, in .pdf format, to [email protected]
before 5 pm on January 21, 2016.
Signature
Executive Director/Chief Executive Officer: __________________________________
Date:
______________________________________________________________
United Way of Williamson County Community Investment Grant Letter of Intent
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