EFSP: PHASE 41 - Colbert County | United Way of Northwest Alabama

Please submit by Monday, April 1 at 5:00 pm. Contact Jennifer McNulty at 256-764-5892 Ext 100 if you have any questions.

Agency's Legal Name:

Agency Principal:

Agency Contact for Application Questions:

Agency Contact for EFSP, if funded?

Agency's Physical Address:

Agency's Mailing Address?

Congressional District of agency's physical location:

Agency's Phone Number:

Agency's Fax Number:

Agency Address for Place of Performance (where the EFSP funded services are provided):

Email address for agency contact:

Federal Employer Identification Number (FEIN):

Agency's DUNS number:

What is the service area for which this funding is being requested? (food, rent, utilities, etc):

Total Amount of funding requested:

Number of people expected to be served with this funding?

Please provide your agency's budget for service area requested.

Please provide your agency's mission statement:

Please describe the services your agency provides:

Please upload your Annual Audit OR Financial Review.

Is this agency non-profit or a unit of government?

Non-profit

Unit of Government

Neither

Please upload a roster of the agency's volunteer board

Is this agency eligible to receive Federal funding?

Is this agency debarred or suspended from receiving or doing business with the federal government?

Does this agency input client data from this grant into CharityTracker aka SEANTracker? (This is a requirement for funding)

Please sign this application:

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