Please submit by Friday, January 15, 2027 Agency Name Agency Address Address City State Zip Code Executive Director Executive Director Email Executive Director Phone Report Contact Report Email Report Phone Program Name (if applicable) Answer the questions below to the best of your ability. Provide feedback for the funding period of July 1, 2025 - June 30, 2026 using estimates for the remainder of the funding cycle. 1. Agency Mission. Please paste or copy your agency’s mission statement below.helped you achieve your mission. 2. Agency Beneficiaries. Briefly describe the intent of your agency’s programs and who primarily benefits from them. Please describe your organization’s impact, specifying the number of beneficiaries or clients served per year and their demographics. 3. Qualifications and expertise. Briefly summarize your agency’s qualifications and expertise (e.g., years of operation, accreditations, experience of staff members, number of volunteers). Please mention any recent major organizational changes. 4. Hold for RE question 5. Agency Funding. List your organization’s most significant funding sources from greatest to least (including the United Way, Whatcom County Health and Community Services and City of Bellingham); dollar amounts are not necessary. Significant funding sources can be defined as sources that make up more than 15% of your program budget. If you have many funding sources, you may list them by category (i.e., federal, state, foundations, individual donors). Please mention any anticipated or recent changes in your future funding or financial position. 6. Program Summary. Briefly summarize the program and its core activities in one or two sentences. 7. Program Purpose. Identify the community need(s) that the program addresses. What are the measurable outcomes that will result from the services provided? 8. Program Status. How long has this program been in operation in Whatcom County? Since your last application, have you made any changes in how you offer services? If this is a new program, how far along is your agency in the planning process? What resources has your organization already invested? File Uploads Board of Directors list with affiliation One file only.10 MB limit.Allowed types: pdf, doc, docx, xls, xlsx. Most recent IRS Form 990 One file only.10 MB limit.Allowed types: pdf, doc, docx, xls, xlsx. Most recent audit, review, or year-end financial statement One file only.10 MB limit.Allowed types: pdf, doc, docx, xls, xlsx. Most recent month-end P&L (March or April of 2026) One file only.10 MB limit.Allowed types: pdf, doc, docx, xls, xlsx. Most recent month-end Balance Sheet (March of April of 2026) One file only.10 MB limit.Allowed types: pdf, doc, docx, xls, xlsx. Additional information may be requested by United Way of Whatcom County.
