COVID-19 Emergency Funds Request - Crisis | United Way of Lincoln County

Date:

Organization Name:

Organization Address

City:

State:

Zipcode:

Phone w/area code:

Fax number w/area code:

Executive Director:

Executive Director Email:

Board Chairperson

Website:

Amount Requested from UWLC: $

Crisis Name:

Describe the need and how it meets the purpose of the Emerging Needs Fund.

What services will you provide with these funds?

Provide the resources or data sets that were used to determine need.

How will you assess individual needs and that the need is caused by the crisis?

Number of individuals you expect to assist with this request?

How will you ensure that the individuals have been connected to available government assistance programs?

How are you collaborating with other agencies to provide these services during this time?

Are you a 501c3 nonprofit organization, a government organization, a school or a faith-based organization?

Yes

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