Allegan County United Way and Volunteer Center LETTER OF INTENT
1.

AGENCY NAME:
 

  • 50 characters left.
2.

CEO or Board President: (Name, Title)
 

  • 350 characters left.
3.

AGENCY AND PROGRAM CONTACT INFORMATION:
First Name:
Last Name:
Job Title:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
Address 3:
City:
State/Province
(US/Canada):
Postal Code:

4.

PROGRAM NAME AND BRIEF DESCRIPTION (25 or less words)
 

  • 350 characters left.
5.

PLEASE INDIATE WHICH IMPACT AREA YOUR REQUEST FALLS UNDER:
INCOME (Promoting financial stability & independence)
HEALTH (Improving people's health)
EDUCATION (Helping children & youth achieve their potential)
6.

Funding amount requested (July 2011- June 2012)
 

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7.

Funding amount requested (July 2012- June 2013)
 

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8.

Please check all that apply:
The agency last submitted an IRS Form 990 or 990ez (Please note date below in "Comment" box: example **990 March 2010)
The agency had its most current audit (or financial review) completed on (Please note date, firm below in "Comment" box below: example **AUDIT March 2010, John Doe CPA )
The agency has a current license to solict (Please note license expiration date below in "Comment" box: example **LS March 2010)
The agency is not required to have a license to solicit. (Please note reason below in "Comment" box why a LS is not required: example **NOT REQUIRED....)
  • Comment:

  • 500 characters left.

THIS NOTICE OF INTENT MUST BE SUBMITTED NO LATER THAN 12:00 PM. September 30, 2010.  LATE REQUESTS WILL NOT BE ACCEPTED.

Questions?
 E-mail mgabriel@acuw.org 
Call 269.673.6545 x12
Write 650 Grand St, Allegan MI 49010