Application for Funding Program Form 2021 Funding Application - Program Application 1. Organization Name * 2. Program Name * 3. Program Contact Information Name * Title * Email * Phone * If someone else should be contacted with questions or to schedule a site visit, enter their name and phone number: 4. For how many years has United Way of Mid-Maine (UWMM) funded this program? * 5. Select the description that best fits your program: * This is a new program, which is why UWMM has not funded it before. This is an existing program, but this is the first time applying for UWMM funding. This program has been funded by UWMM previously, but not continuously (has been unfunded one or more years since first successful appliaction). This program has been continuously funded by UWMM since its first successful application. 6. Why does this program need funding from UWMM? (250 words max) * If you receive matching funds or other additional funding when you receive UWMM funding, please indicate how much. 7. How much are you requesting? * $ 8. Is this an increase to what you received for the current funding cycle? * Yes No Did not receive funding from UWMM for this year How much did you receive for the current funding cycle? * $ Why are you requesting an increase? * 9. Provide a 25-word summary of this program's purpose. (25 words max) * 10. How is your program uniquely important to the community’s well-being? (400 words max) * If your services are similar or complementary to those of other programs, highlight any collaborations that can help UWMM understand your relationship with those programs. 11. Program Updates List any major program changes—since last review and expected in the coming year—including those related to program revenue, key personnel, program delivery, service delivery capacity, or service population. Since last report to UWMM (or in past two years, if first time applying): (400 words max) * Expected in coming year: (400 words max) * 12. Select the one outcome that your program most contributes to: * Your choice determines the funding stream your program will be considered for. Health: All individuals in Mid-Maine are in safe and healthy environments with access to health supports and services. Education: All children grow up in a stable environment—safe, healthy, and ready to learn. Financial Stability: All Mid-Mainers have access to resources and training to secure opportunities to be financially stable. 13. How does your program contribute to this outcome? Select all that apply. * Provides a direct service in behavioral and/or physical health areas Increases access/reduces barriers to direct services Increases capacity/resources for direct services Advocates for behavioral and/or physical health Collaborates with other programs/services in behavioral and/or physical health 13. How does your program contribute to this outcome? Select all that apply. * Provides a direct service in early learning and youth success/education areas Increases access/reduces barriers to direct services Increases capacity/resources for direct services Advocates for early learning, youth success, and/or education Collaborates with other programs/services in early learning, youth success, and/or education 13. How does your program contribute to this outcome? Select all that apply. * Provides a direct service in financial stability-related areas Increases access/reduces barriers to direct services Increases capacity/resources for direct services Advocates for financial stability Collaborates with other programs/services in financial stability-related areas 14. Define Your Year Many of the following questions ask for annual information. This can be by calendar year or by fiscal year. Define when the twelve-month period you use starts and ends (for example, Jan 1-Dec 31 or July 1-June 30). Start Month: * January February March April May June July August September October November December Start Day: * End Month: * January February March April May June July August September October November December End Day: * 15. How much did we do? Provide the total number of people served who: reside in the UWMM service area or were served in the UWMM service area (According to how your program tracks numbers served.) Provide numbers for both (1) the most recent year for which you have complete data and (2) for the current year. Goal Number Served * Use the time frame you defined in question 13. How much do you hope to do this year? Estimated Number Served - Current Year * Use the time frame you defined in question 13. How much are you on track to do this year? Total Number Served - Most Recent Completed Year * Use the time frame you defined in question 13. How much did you do last year? How well did we do it? (Health) Provide data for the people your program served who either reside in or were served in UWMM's service area. 16. Select ONE performance measure that best demonstrates the quality of service your program provides. * Average time on wait list Average time from referral to assessment Average time from assessment to admission into services Percent of clients who remain in school or employed during treatment Percent of clients who report a positive experience with the program Percent of clients who participate in a support network on a regular basis Percent of clients who have contact with family, friends, or neighbors that do not live with them Percent of clients involved in community activities Percent of clients who complete a skills-based program on goal setting, self-management, and/or problem-solving skills Percent of clients who received all available/requested services Percent of clients who access more than one service type Percent of clients satisfied/very satisfied with service received Percent of clients rating quality of services as good or better Percent of new clients Percent of returning clients Percent of staff fully trained with all required certifications/licenses Percent of clients who would recommend the program Percent of staff meeting/exceeding performance evaluation measures Define "regular basis": * For example: Regular basis for a program offered daily is an average attendance of 3 or more times a week. 17. Goal percentage for current year: * Use the time frame you defined in question 13. How well do you hope to do it? % 18. Estimated percentage for current year: * Use the time frame you defined in question 13. How well are you on track to do it? % 19. Percentage for most recent completed year: * Use the time frame you defined in question 13. How well did you do it last year? % 17. Goal number for current year: * Use the time frame you defined in question 13. How well do you hope to do it? 18. Estimated number for current year: * Use the time frame you defined in question 13. How well are you on track to do it? 19. Number for most recent completed year: * Use the time frame you defined in question 13. How well did you do it last year? Time Unit * Hours Days Weeks Months How well did we do it? (Education) Provide data for the people your program served who either reside in or were served in UWMM's service area. 16. Select ONE performance measure that best demonstrates the quality of service your program provides. * Percent of staff/volunteers with new knowledge and/or skills Percent of time spent teaching/counseling children on social-emotional learning skills Percent of time spent providing children social-emotional supports Percent of evidence-based curriculum implemented Percent of hours of targeted literacy supports children receive each week Percent of eligible youth who participate in the school or community-based out-of-school program on a regular basis Percent of parents/guardians involved in program with their children Percent of children under five who have completed developmental screening Percent of clients who received all available/requested services Percent of clients who access more than one service type Percent of clients satisfied/very satisfied with service received Percent of clients rating quality of services as good or better Percent of returning clients Percent of staff fully trained with all required certifications/licenses Percent of clients who would recommend the program Percent of staff meeting/exceeding performance evaluation measures Percent of clients who complete a skills-based program on goal setting, self-management, and/or problem-solving skills Define "eligible youth": * Define "regular basis": * For example: Regular basis for a program offered daily is an average attendance of 3 or more times a week 17. Goal percentage for current year: * Use the time frame you defined in question 13. How well do you hope to do it? % 18. Estimated percentage for current year: * Use the time frame you defined in question 13. How well are you on track to do it? % 19. Percentage for most recent completed year: * Use the time frame you defined in question 13. How well did you do it last year? % How well did we do it? (Financial Stability) Provide data for the people your program served who either reside in or were served in UWMM's service area. 16. Select ONE performance measure that best demonstrates the quality of service your program provides. * Percent of clients with low incomes who pursue financial literacy education Percent of individuals who complete the program Percent of clients who received all available/requested services Percent of clients who access more than one service type Percent of clients satisfied/very satisfied with service received Percent of clients rating quality of services as good or better Percent of returning clients Percent of staff fully trained with all required certifications/licenses Percent of clients who would recommend the program Percent of staff meeting/exceeding performance evaluation measures Percent of clients who complete a skills-based program on goal setting, self-management, and/or problem-solving skills 17. Goal percentage for current year: * Use the time frame you defined in question 13. How well do you hope to do it? % 18. Estimated percentage for current year: * Use the time frame you defined in question 13. How well are you on track to do it? % 19. Percentage for most recent completed year: * Use the time frame you defined in question 13. How well did you do it last year? % What was the difference made? (Health) Provide data for the people your program served who either reside in or were served in UWMM's service area. 20. Select ONE performance measure that best demonstrates how your clients are better off. * Percent of individuals who met treatment/planned goals Percent of individuals who improve their functioning or self-sufficiency as measured by an assessment Percent of clients who show a decrease in emergency department use Percent of clients who report a decrease or elimination in substance use Percent of individuals identified as potentially at risk for substance misuse and referred for behavioral health services Percent of individuals identified as potentially at risk for suicide and referred for behavioral health services Percent of participants that confirm regular use of new nutrition skills or knowledge outside of the program Percent of clients who met their program/service goals Percent of clients who made progress on their program/service goals Percent of students/clients demonstrating new knowledge in relevant areas Percent of clients demonstrating improved self-reliance Percent of clients whose basic needs are met Percent of homeless individuals/families that secure permanent and/or supportive housing Percent of clients accessing shelter during the day in extreme weather 21. Goal percentage for current year: Use the time frame you defined in question 13. What difference do you hope to make? % 22. Estimated percentage for current year: * Use the time frame you defined in question 13. What difference are you on track to make? % 23. Percentage for most recent completed year: Use the time frame you defined in question 13. What difference did you make last year? % What was the difference made? (Education) Provide data for the people your program served who either reside in or were served in UWMM's service area. 20. Select ONE performance measure that best demonstrates how your clients are better off. * Percent of children/families referred to services to address toxic stress and/or trauma Percent of children/families accepted into services to address toxic stress and/or trauma Percent of children who show improvement in emotional/behavioral functioning Percent of children who demonstrate positive coping skills and behaviors Percent of children who demonstrate growth in social-emotional skills Percent of children meeting their milestones for social-emotional development Percent of children who demonstrate increased language and reading skills Percent of English language learners who demonstrate increased English language proficiency Percent of children who are at or above the appropriate grade level for reading Percent of children who show growth in their numeracy and math skills Percent of children who are at or above grade level for math Percent of parents who implement strategies to reduce children’s and families’ exposure to ACEs Percent of children and adolescents who have reduced exposure to ACEs Percent of patients screened for ACEs Percent of children who are referred for appropriate services after screening positive for exposure to ACEs Percent of students who demonstrate improved job-related skills, including interpersonal skills Percent of students who improve their social-emotional skills Percent of students who earn passing grades in core subjects (ELA, Math, Science) Percent of students with special needs who make progress on their goals Percent of high school students who are on-track to graduate high school within four years Percent of fourth-year high school students who graduate Percent of students/clients showing growth in developmental areas Percent of children enrolled in the program who successfully transition to kindergarten 21. Goal percentage for current year: Use the time frame you defined in question 13. What difference do you hope to make? % 22. Estimated percentage for current year: * Use the time frame you defined in question 13. What difference are you on tack to make? % 23. Percentage for most recent completed year: * Use the time frame you defined in question 13. What difference did you make last year? % What was the difference made? (Financial Stability) Provide data for the people your program served who either reside in or were served in UWMM's service area. 20. Select ONE performance measure that best demonstrates how your clients are better off. * Percent of students who gain job-related skills as a result of engagement in work experiences or experiential learning opportunities Percent of participants who obtain a credential of value Percent of participants who earn a college degree Percent of individuals who gain skills needed to pursue credentials of value Percent of individuals who increase their wages and/or access to benefits Percent of individuals/families who secure quality childcare to support employment or training Percent of individuals/families who access reliable transportation to support employment or training Percent of individuals/families who access supports (SNAP, subsidized housing, heating assistance, etc.) to supplement income Percent of individuals who earn job-relevant credentials for career advancement Percent of job seekers who secure employment Percent of individuals who maintain employment for at least three months Percent of households that move from crisis to stable on a self-sufficiency index Percent of individuals/families who obtain temporary housing Percent of individuals/families who secure permanent and/or supportive housing Percent of clients with greater access to supports and services Percent of clients who met their program/service goals Percent of clients who made progress on their program/service goals Percent of students/clients demonstrating new knowledge in relevant areas Percent of clients employed within a year of completing program/receiving services Percent of clients demonstrating improved self-reliance Percent of individuals who improve their functioning or self-sufficiency as measured by an assessment Percent of students who demonstrate improved job-related skills, including interpersonal skills 21. Goal percentage for current year: Use the time frame you defined in question 13. What difference do you hope to make? % 22. Estimated percentage for current year: * Use the time frame you defined in question 13. What difference are you on track to make? % 23. Percentage for most recent completed year: * Use the time frame you defined in question 13. What difference did you make last year? % Action Plan 24. List your program’s planned objectives for the upcoming year. (400 words max) * 25. List your program’s objectives from last year and share the results. (500 words max) * Did you meet your goals? Were you successful in attaining your objectives? Success Stories 26. Provide at least one client/consumer “success story,” in their own words, if possible. UWMM intends to share these stories publicly to showcase the impact of your partnership with United Way in our community. * 27. Previous Year Actual Income and Expenditures Provide your Previous Year Actual Income and Expenditures in the table below, using the time frame you defined in question 13. List funding received by source: Government (local, state, or federal)-sourced funding UWMM Other United Ways (UWs) Program fees and/or member dues All other sources a. Government * $ b. UWMM * $ c. Other UWs * $ d. Fees/Dues * $ e. Other * $ Total Income $ Total Expenditures * $ 28. Upcoming Year Budgeted Income and Expenditures Provide your Upcoming Year (the year for which you're requesting UWMM funds) Budgeted Income and Expenditures in the table below, using the time frame you defined in question 13. List funding received by source: Government (local, state, or federal)-sourced funding UWMM Other United Ways (UWs) Program fees and/or member dues All other sourcesBudgeted UWMM amount should be what you're requesting on this application (question 6). a. Government * $ b. UWMM * $ c. Other UWs * $ d. Fees/Dues * $ e. Other * $ Total Income $ Total Expenditures * $ 29. Budget Narrative If there is anything unusual or remarkable about your budget that you'd like to explain, use this space to do so. For example: Why your program is operating at a loss Which other United Ways you receive funding from A description of your government or other source funding Whether you are including any unconfirmed funding Why there is a large discrepancy between your Previous Year Actual and Current Year Budget amounts Additional Information [Optional] 30. What else would you like reviewers to know about your program? (Optional, 400 words max) This is an opportunity to define or explain anything from previous questions that you haven't had the chance to share, yet. For example: If funding had been rescinded or previously denied, what you've done to address UWMM's concerns How an outlier skews your data for one of your performance measures Why your projected numbers are significantly different from most recent numbers If your program is new, why a new program is needed If you are human, leave this field blank. Submit
