Weyburn & District United Way logo

 

Weyburn and District

Box 608, Weyburn, SK  S4H 2K7

Agency Application Form

Organization: *
Official Contact: *
Phone *

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Email: *
Confirm *
Address: *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *

Your organization must be local in nature. You may be a National Agency but must have a local representative or local board.

Local Contact: *
Phone *

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Email: *
Confirm *
Address: *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Saskatchewan Corporations Branch Corporation Number (if applicable)
Date of Incorporation:
Canada Revenue Agency Charitable Number:
Fiscal Year:
Geographic Service Area: *

Programs and Services:

Describe the program/service for which you would request United Way funding.
Note: Weyburn & District United Way does not provide on-going funding for capital expenditures.
Program/Service 1
Program/Service 2
# of local clients served

As an organization you must:

1. provide community services with emphasis on health and social needs.
2. not exclude persons from participation in agency affairs or programs by virtue of race, ethnicity, colour, religion, age, disability or gender.

Your agency must show:

1. a need for the program/service.
2. the ability to effectively offer the program/service
3. progress and results of the program/service
Do volunteers play a role in your organization?
How many local volunteers?
What is their role?
Please list your sources of funding:
Why do you want to become a Member Agency of the Weyburn & District United Way?
Please list all the programs and services that your organization provides for your clients.

Weyburn & District United Way will assess this application and if accepted will request you to forward the following information:

Current audited financial report
List of the Board Members
All materials from your organization that you believe would be relevant to this application.
 

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