Northern
Berkshire United Way
One‑Time
Grant Application
Agency/Organization
Name:_____________________________________App. Date:________
Contact:____________________________________________
Address:
____________________________________________________________________
Phone:______________
Fax:___________ E‑Mail:____________ Web site:_______________
One‑time
grant requested for (list program name, item or event):
________________________
___________________________________________________________________________
___________________________________________________________________________
Have
you/do you plan to request support from other sources, and who are
these?__________
___________________________________________________________________________
Please
submit this form along with attachments to further explain the request.
Grant
recipients are required to report to NBUW the results or outcomes facilitated
by the grant. Please specify here, or in an attachment the results you expect
to achieve, and how and when you will report on this to
NBUW:__________________________________________________
___________________________________________________________________________
Amount
Requested:_______________________ (Please be specific. Do not give a range.)
Funding
Schedule (Requested payment dates and amounts)___________________________
Please
list here the attached material: ____________________________________________
___________________________________________________________________________
One‑time
grants are available to both member and non‑member agencies. Grants to
member agencies may not normally be used to supplement programs that were not
fully funded during NBUW's annual allocation process.
Requests
are normally reviewed at the beginning of each calendar quarter; decisions
within 30 days thereafter. Please indicate if you request earlier
consideration.
With
questions or comments, please call 663‑9062, e‑mail
noberkuw@bcn.net, or write to NBUW, 85 Main Street, North Adams, MA, 01247.
Thank you!
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