Allocation Funding Application CLICK HERE for a hard copy of the application to prepare for your submission. Once you begin the online application, it needs to be completed as it will not save your work. Step 1 of 3 33% Name of Agency:*Agency Contact:* First Last Title:Address: Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Fax:Email:* Website:Communities served by organization (Please select all that apply):DarienDelavanEast TroyElkhornFontanaGenoa CityHoney CreekLake GenevaLyonsPell LakeSharonSpringfieldWalworthWilliams BayZendaOther communities:Number of years in existence:Agency Mission/Purpose:Name of Program to be Funded:*Same as Agency Contact? Check here and skip section. Program Contact:Title:Address: Street Address Address Line 2 City State ZIP Code Phone:Fax:Email: Website: Please provide a detailed description of the program:* AGENCY FINANCIAL REQUIREMENTSAmount of Funding Requested:*If so, whom?Are there other sources of funding that you receive?Are there other agencies in Walworth County that provide a similar service? If so, whom?Do you collaborate with them? Yes No If so, how?How long has the program been in existence?*How many Walworth County residents does your program serve? When answering, do not duplicate. For example, individuals and or families are counted only once regardless of the number of times they utilize the program.*What are the qualification requirements for the recipients to receive program services?*Any other program details you wish to include? ALICE:A newly revealed demographic is an acronym that stands for Asset Limited Income Constrained Employed. United Way unveiled the first ALICE report that showed 44% of Walworth County households are unable to afford life’s basic necessities. This exceeds the official federal poverty statistics. We are sharing this project data and looking for agency partners in order to assist our residents actively working in our county but still living paycheck to paycheck – one crisis away from severe poverty.Are there ways your agency would be able to assist, or already assist, United Way of Walworth County in identifying ways to help this population?We would like to actively participate in the ALICE project. Yes No The following MUST be included with your Application.Please feel free to include any additional information you feel would better outline your programs to us.Attach PDF Files: Drop files here or Accepted file types: pdf. Marketing:Do you utilize the United Way of Walworth County logo on your publications and/or Website? [i.e. brochures; power point presentations]Have you participated in United Way sponsored or supported events? [i.e. RUN United; Day of Action]Certification:In submitting this request, I certify that we meet the standards required for funding by United Way and, if selected as a participating agency, we will comply with the appropriate requirements if and/or when funding is awarded.Signature:*Title:*Date:* This iframe contains the logic required to handle Ajax powered Gravity Forms.