FY24 Community Impact Grant - Application Form

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  • Part 2 - Program Information
  • Part 3 - Required Documentation
  • FY24 Community Impact Grant - Application Form (Preview)
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PART I - Agency Information

Agency Information
What category is the focus of your request?
Agency's Address
Mailing Address (if different)
Primary Contact Information
Select all areas of which your agency has demonstrated support of United Way of Washington County, MD:
Collaborating Agency Information
Are there collaborating agencies associated with this grant? For the purposes of this application, list only the agencies that will be receiving financial support or sharing responsibilities reporting outputs and outcomes.

Collaborating Agency Information

Please provide details for each collaborating agency into the fields below, where relevant. Copy, paste, and answer each of the questions for each agency partner. 

  1. Agency Name
  2. Contact Name (First and Last Name)
  3. Agency Email
  4. Agency Phone
  5. Agency Address
  6. Agency EIN Number
  7. Agency ED/CEO President Name (First and Last Name)
  8. Agency Board Chair Name
  9. Agency Website URL
  10. List how agency has demonstrated support of the United Way of Washington County, MD: Day of Caring, Campaign, Telethon, Golf Shot, Day of Caring, Social Media Shares, Other