APPENDIX 5: SUBMISSION CHECKLIST __Original Proposal __Cover Sheet signed by 501(c)(3) Applicant Executive Director and 501(c)(3) President/Chair of Board of Directors Complete Narrative __ I. Response to UWBC Impact Funding II. Program Explanation and Rationale __ A. Description __B. Goals and Rationale __C. Status III. Program Outcomes __A. Logic Model __B. Outcome Explanation IV. Program Service and Evaluation __ A. Eligibility Criteria __B. Evaluation V. Program Financials __A. Rationale __B. Proposed Budget and Budget Narrative __C. Supplementary/Sustaining Investment __8 Copies of Original Proposal, each copy three hole punched and bound by clip. ADDITIONALLY ONE COPY OF THE FOLLOWING DOCUMENTS MUST BE SUBMITTED: __Current list of Board of Directors __Most recent or Financial Statement __Most recent 990 __Appendix 5: Signed Submission Checklist __Appendix 6: Signed Anti-Terrorism Compliance Document __Appendix 7: Signed Anti-Discrimination Policy __Appendix 8: Signed 501(c)(3) Verification __Appendix 9: United Way Participation Checklist __A copy of your Internal Revenue Service 501(c)(3) Determination Letter All proposals must be received at the United Way of Blair County Office by 4:00 pm on Friday, March 17, Mail or hand-deliver to: 2017 – United Way of Blair County 5414 Sixth Avenue, Suite C Altoona, PA 16602 I certify that this application is complete and understand that missing items may result in the reduction of points. Signature of 501(C)(3) Executive Director Printed Name Date
APPENDIX 5: SUBMISSION CHECKLIST __Original Proposal __Cover Sheet signed by 501(c)(3) Applicant Executive Director and 501(c)(3) President/Chair of Board of Directors Complete Narrative __ I. Response to UWBC Impact Funding II. Program Explanation and Rationale __ A. Description __B. Goals and Rationale __C. Status III. Program Outcomes __A. Logic Model __B. Outcome Explanation IV. Program Service and Evaluation __ A. Eligibility Criteria __B. Evaluation V. Program Financials __A. Rationale __B. Proposed Budget and Budget Narrative __C. Supplementary/Sustaining Investment __8 Copies of Original Proposal, each copy three hole punched and bound by clip. ADDITIONALLY ONE COPY OF THE FOLLOWING DOCUMENTS MUST BE SUBMITTED: __Current list of Board of Directors __Most recent or Financial Statement __Most recent 990 __Appendix 5: Signed Submission Checklist __Appendix 6: Signed Anti-Terrorism Compliance Document __Appendix 7: Signed Anti-Discrimination Policy __Appendix 8: Signed 501(c)(3) Verification __Appendix 9: United Way Participation Checklist __A copy of your Internal Revenue Service 501(c)(3) Determination Letter All proposals must be received at the United Way of Blair County Office by 4:00 pm on Friday, March 17, 2017 – Mail or hand-deliver to: United Way of Blair County 5414 Sixth Avenue, Suite C Altoona, PA 16602 I certify that this application is complete and understand that missing items may result in the reduction of points. Signature of 501(C)(3) Executive Director Printed Name Date
RFP%202017.docx