This letter of interest will be submitted to the Impact Grant Committee for review. Programs invited to complete a full application will be notified via email. This year, the Community Impact Grant application will follow SMART guidelines: all grant proposals must be Specific, Measurable, Attainable, Relevant, and Timely. The final application is structured in sections with those titles. Step 1 of 4 - Contact information 25% Basic InformationPlease provide relevant contact information for the grant on this page.Program or Project Title*Agency or Group Applying*Mailing Address*Chief Professional Officer*Contact Person*Contact Email* Contact Phone Numer*Are you a 501(c)(3) organization?*YesNoWhat is your EIN number?*Have you applied for a Community Impact Grant in the past?*YesNoWhat year did you most recently apply for a Community Impact Grant?*Did you receive the Community Impact Grant in that year?*YesNoWhat IMPACT AREA will this project focus on?*1001- School readiness and access to high quality learning1002- Early grade reading and other educational supports1003- Middle grade success and transitions1004- High school graduation/dropout prevention1005- Post-secondary success (includes career and college access, preparation, and completion)1006- Out of school time (summer, after school, etc)1007- Reading, tutoring, and mentoring support1008- Youth development1009- Family engagement1010- Wrap around community supports1999- Another education-related program2001- Job/ workforce development and training2002- Income supports (screening and enrollment in public benefits)2004- Savings and asset building programs2005- Financial education, coaching, and service integration2006- VITA/tax assistance2007- Youth employment/financial support2008- Veteran employment/financial support2009- Access to affordable credit/credit repair2999- Other income/financial stability-related programs3001- Healthcare outreach and entrollment3002- Other access to healthcare (includes clinics and screenings)3003- Healthy beginnings (prenatal care, healthy birth weight, immunizations, etc)3004- Healthy eating and physical activity (increasing access to and awareness of nutrition and exercise)3006- Health education and public awareness3007- Mental and behavioral health services3008- Services for people with physical disabilities3009- Services for people with intellectual/ developmental disabilities3010- Substance use disorder services3011- Senior/elder support (includes caregiving)3012- Home healthcare/assistance3013- HIV/AIDS service3014- Family planning (includes pregnancy prevention)3999- All other health-related programs4001- Food banks, delivery services, and meal programs4002- Clothing and household furnishing service4003- Transportation services4004- Emergency shelter care for people experiencing homelessness4015- Housing (permanent, transitional, supportive, affordable, etc)4008- Child care4009- Disaster prevention and relief service4010- Domestic violence, sexual assault, or human trafficking4011- Legal aid and public defender service4012- Prisoner re-entry support4016- Emergency cash assistance (includes rental, utility assistance)4017- Foster care services4999- All other basic needs/crisis prevention5001- Volunteer engagement/volunteer center5002- 2-1-1- or other information and referral5003- Community collaboration, planning, backbone support5006- Diversity, inclusion, race, and equity5007- Social innovation5008- Advocacy/public policy engagement5999- All other community capacity buildingPlease choose the ONE area that best describes your program's focus.Please tell us about the project, your goals, and the project's alignment with the mission and goals of United Way Worldwide and United Way of Greater Fall River*Please take up to 500 words for this brief description.Describe your organization's relationship with UWGFR, including volunteer work, business relations, committee involvement, etc.*What is the approximate cost-per-unit of service for this program?*Total funding request* Additional DocumentationImpact Grants will not be accepted without the following documents: A list of the agency's Board of Directors Proof of 501(c)(3) status Current Certificate of Solicitation from the Commonwealth of MA Pages 1-11 from your most recent Form 990.Board of Directors*Proof of 501(c)(3) Status*Certificate of Solicitation*Pages 1-11 of recent Form 990* Drop files here or DisclosuresA signed Non-Discrimination Policy disclosure and Patriot Act disclosure are required for all Community Impact Grant Applicants.Non-Discrimination Policy- Signature required*Our agency has adopted a stated policy of nondiscrimination in regard to all persons, irrespective of their race, color, creed, religion, national origin, sex, sexual orientation, age, disability, or veteran’s status, and compliance with all requirements of law and regulations, with respect to employment, volunteer participation and the provision of servicesPatriot Act DisclosureIn compliance with the spirit and intent of the USA PATRIOT Act and other counterterrorism laws, United Way of Greater Fall River requires that each agency (“Organization”) be in compliance with United Way of Greater Fall River and the United Way of America’s (“UWA”) compliance program by certifying the following:This Organization is not on any federal terrorism “watch lists,” including the list in Executive Order 13224, the master list of specially designated nationals and blocked persons maintained by the Treasury Department, and the list of Foreign Terrorist Organizations maintained by the State Department*.*ComplyDo Not ComplyIn this form, “material support and resources” means currency or monetary instruments or financial securities, financial services, lodging, training, expert advice or assistance, safe houses, false documentation or identification, communications equipment, facilities, weapons, lethal substances, explosives, personnel, transportation, and other physical assets, except medicine or religious materials.This Organization does not, will not and has not knowingly provided financial or material support or resources to any entity that has knowingly concealed the source of funds used to carry out terrorism or to support Foreign Terrorist Organizations.*ComplyDo Not ComplyThis Organization does not, will not and has not knowingly provided financial, technical, in-kind or other material support or resources* to any individual or entity that is a terrorist or terrorist organization, or that supports or funds terrorism.*ComplyDo Not ComplyThis Organization does not, will not and has not knowingly provided or collected funds or provided material support or resources with the intention that such funds or material support or resources be used to carry out acts of terrorism.*ComplyDo Not ComplyThis Organization does not regrant to organizations, individuals, programs and/or projects outside of the United States of America with out compliance with IRS guidelines.*ComplyDo Not ComplyThis Organization takes reasonable, affirmative steps to ensure that any funds or resources distributed or processed do not fund terrorism or terrorist organizations.*ComplyDo Not ComplyThis Organization takes reasonable steps to certify against fraud with respect to the provision of financial, technical, in-kind or other material support or resources to terrorists and terrorist organizations.*ComplyDo Not ComplyPatriot Act Consent- Signature Required*I certify on behalf of the Organization listed above that the foregoing is true, and that all United Way funds and donations will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes and executive orders.” SubmissionI agree to conduct the program/project as outlined in the application above.*Should modifications be required, United Way asks that notification be sent to LIVEUNITED@uwgfr.org outlining programmatic changes and revised outcomes. Failure to meet any of the requirements of funding will result in suspension of remaining payments, as well as disqualification from submitting future proposals to be considered for Impact Grants.AgreeAccuracy*I attest that the information provided herein is as accurate as possible.AgreeSignature of Chief Professional Office*