Letter of Intent | Lake Area United Way

Contact Information

Organization Name

Today’s Date

Address

City

State

ZIP Code

Address

City

State

ZIP Code

Primary Contact’s Name

Primary Contact’s Email Address

Executive Directors Name

Executive Directors Email Address

Program Information

Program Name

Program Description

Briefly summarize the key elements of your program or service (not your organization). This description may be used by United Wa

Additional Program

Yes

Program Name

Program Description

Additional program

Yes

Program Name

Program Description

Organization Information

Tax Id Number

Year Founded

Organization's Website Address *If not applicable, write N/A in box.

Organization's Mission Statement

Organization Overview

Upload Your 501c3 (Letter of Determination)

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3 MB limit.
Allowed types: pdf.

Upload Your Most Recent 990

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25 MB limit.
Allowed types: pdf.

Upload Your Agency's Bylaws

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25 MB limit.
Allowed types: pdf.

Legal

Compliant With Federal, State and Local Regulations
Do you affirm that your organization is compliant with the Sarbanes-Oxley Act, Whistler-Blower and Document Retention Policies and all other federal, state and local regulations?

Yes

OK State Renewal Certificate with Secretary of State
Upload a copy of your current Certificate of Registration Renewal. Reference: OK Secretary of State Solicitation of Charitable Contributions Act.

Upload

One file only.
25 MB limit.
Allowed types: pdf.

Is your Registration Renewal Up To Date?

Yes

Certificate Renewal Note

Financials

Audited Financials

LAUW Policy: (*Based on total agency prior year annual operating revenue)

Under $100,000 – compilation prepared by CPA with footnotes
$100,000 - $250,000 – compiled financial statements prepared on GAAP basis by independent CPA & a periodic review of internal controls (every 18 months or when there is a change in executive director)
$250,001 – $500,000 – Reviewed financial statements prepared on a GAAP basis by independent CPA
> $500,000 – Audited financial statements prepared on GAAP basis by an independent CPA.

Does your organization have audited financials from a CPA firm?

Yes

Audit Date

If so, when was your most recent audit completed?

Upload Your Current Audit Report

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200 MB limit.
Allowed types: pdf.

If no, upload your most recent financial statements.

One file only.
200 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Strategic Plan

Does your organization have a strategic plan in place? *Recommended by Lake Area United Way

Yes

Strategic Plan Adoption

Strategic Plan Update

Governance

Board of Directors Terms

Board of Directors Listing

Provide a list of organization's Board of Directors and their occupations
One file only.
2 MB limit.
Allowed types: pdf.

Terms of Agreement

United Way does not require submission of certain documents referenced above but reserves the right to view them upon request. Please indicate your acceptance of this statement.

I Agree

I understand the eligibility criterion for this competitive application process:

Local public agencies, 501c3 nonprofit organizations, and government authorities may submit one application by the deadline.
Previous grantees must be in good standing in order to reapply, i.e. timely and complete reporting.
Applicants should have documentation confirming a valid solicitation license or exemption.
Applicants will maintain current financial records and will adhere to LAUW policy regarding audited financial statements:
- Under $100,000 - compilation prepared by CPA with footnotes.
- $100,000 - $250,000 - compiled financial statements prepared on GAAP basis by independent CPA & a periodic review of internal controls (every three years or when there is a change in executive director).
- $250,001 - $500,000 - Reviewed financial statements prepared on a GAAP basis by independent CPA.
- > $500,000 - Audited financial statements prepared on GAAP basis by an independent CPA.
Programs should be based on data and serve Cherokee and/or Muskogee County residents through evidenced-based programming, with at least one year of solid results using an evaluation component.
Proposals are sought that collaborate or take a collective impact approach with other initiatives.

Executive Director Signature

Sign above

Date Signed

By signing this form you agree that all information is accurate.

Board of Directors – Chair Signature (Your organizations board chairperson)

Sign above

Date Signed

By signing this form you agree that all information is accurate.