Weyburn & District United Way logo

 

Weyburn and District

Box 608, Weyburn, SK  S4H 2K7

Funding Application 2017 for Payment 2018

Organization: *
Official Contact: *
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Board Chair: *
Phone *

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Email: *
Confirm *
Saskatchewan Corporations Branch Corporation Number (if applicable)
Date of Incorporation
Canada Revenue Agency Charitable Number: *
Geographic Service Area: *
Number of Staff (FTE's) Provincially:
Number of Staff (FTE's) Locally:
Number of Volunteers Locally:

FOCUS AREA FUNDING REQUESTS

Please note you can download the Definitions of the "Focus Area" .pdf at the top of this webpage.
Funding Request for Focus Area "ALL THAT KIDS CAN BE"
 Success in School 
 Community Engagement & Leadership Development 
 Emotional & Physical Wellbeing 
 Community Wide Strategies 
 Other 
Funds Requested for 'ALL THAT KIDS CAN BE"
Funding Request for Focus Area "FROM POVERTY TO POSSIBILITY
 Food Security 
 Housing Stability 
 Employment 
 Financial Literacy & Individual Support 
 Community Wide Strategies 
 Other  
Funds Requested FOR "FROM POVERTY TO POSSIBILITY"
Funding Request for Focus Area "HEALTHY PEOPLE - STRONG COMMUNITIES"
 Aboriginal Peoples 
 People with Disabilities 
 Seniors 
 Newcomer Settlement & Integration 
 Community Mental Health & Wellbeing 
 Sexual &/or Domestic Violence 
 Neighbourhood Development & Engagement 
 Organizational Capacity Building & Leadership Development 
 Volunteer Engagement & Mobilization 
 211 
 Community Wide Strategies 
 Other  
Funds Requested for "HEALTHY PEOPLE - STRONG COMMUNITIES"
Total Amount Requested: *

COMMUNITY IMPACT

The Weyburn and District United Way is accountable for investing donors' gifts in organizations whose programs and services result in positive and measurable change for the citizens they serve. The United Way also recognizes that resources must be distributed in order to address key issues in the community.
1. What are your organization's local goals for the Weyburn and district for the next 1 - 3 years?
Criteria - Describe and include with the application: Goals identified, Local Action Plan, Strategic Plan, Mission and Vision Statements (if applicable).

COLLABORATION

The Weyburn & District United Way encourages and supports a multi-sectional approach to community building. By working together we strengthen our capacity to address long-term challenges and take advantage of opportunities.

2. Describe your local programs including any in which you partner with another organization and outline the results.

Criteria - Describe
- Partnering with other organizations
- Specifically how your partners are involved in this Collaborative Process. Identify local participants/beneficiaries
- Long term benefits
- The organization's Cost Saving as a result of Collaboration
a. Program Name
# of local participants directly involved
Long term benefits of the Local Program
Length of Program
Partner
Your Role in the Partnership
Cost Savings Realized
b. Program Name
# of local participants directly involved
Long term benefits of the Local Program
Length of Program
Partner
Your Role in the Partnership
Cost Savings Realized
c. Program Name
# of local participants directly involved
Long term benefits of the Local Program
Length of Program
Partner
Your Role in the Partnership
Cost Savings Realized
d. Program Name
# of local participants directly involved
Long term benefits of the Local Program
Length of Program
Your Role in the Partnership
Cost Savings Realized
3. Are you aware of other organizations in Weyburn and area that provide similar programs to yours?
a. If so, have you considered collaborating with these organizations.

NEEDS ASSESSMENT

4. What does your organization do to identify local community needs?
a. Does your organization conduct independent needs assessment?
b. Does your organization participate in any coalitions or committees to identify local issues and local community needs more effectively?
Please identify and give a brief description of the focus of these groups.
Criteria:
- What community needs has your organization or coalition identified?
- Provide description
- Identify your organization's planned participation

ORGANIZATION AND OUTCOMES

5. If your organization is affiliated with a provincial or national body, describe the organization's decision-making processes. Please comment on the level of authority that the local governance body has in relation to these processes
6. Describe how your organization's staff, volunteers and the people served are representative of the Weyburn and District community.
7. Describe the program or service that your organization is able to provide BECAUSE of the funding from the Weyburn and District United Way.
8. What are the anticipated measurable Outcomes of your proposed program or service?

FINANCIAL INFORMATION

The Weyburn and District United Way is accountable to its donors for ensuring that their financial gifts are managed well and invested in programs that will benefit Weyburn and Area citizens.

The following is to be completed for WEYBURN & AREA ONLY
Federal Government *
Provincial Government *
City of Weyburn *
Donor's Choice *
Other Grants *
Fee for Service *
Fundraising *
Donations *
Business Income *
Other *
Weyburn & District United Way *
TOTAL REVENUE *
Salaries *
Program Costs *
Overhead *
TOTAL EXPENSES *
Surplus/Deficit *

MULTI-YEAR AGREEMENTS

Please indicate funders with whom your organization has a multi-year agreement.
Funder #1
Year ________ of
Total years of Agreement
Funder #2
Year ________ of
Total years of Agreement
By checking this form, we verify that the information provided in this application is complete and accurate.
 We agree 
Upload copy of financial report *
Upload a signed copy of the Membership Agreement *
File Upload - Strategic Plan
File Upload Mission Statement
File Upload Vision Statement
File Upload - Copy of Annual Report identifying services provided in Weyburn and District
File Upload - Letters of support

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