United Way of Charles County

Partner Application

Below is the 2019 Partnership Application. This completed form and supporting documents must be completed to be a Partner in the 2019 Campaign. We must receive your online submission as well as one hard copy of the application and supporting documents. First time or lapsed partners must also complete and submit Part IV, as well as the "Supplement for First Time Applicants" form.

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PART I - Agency Information

Today's Date *

Month

Day

Year

Agency's Name *

Employer Identification Number (EIN) *

Street Address *

City *

State *

Zip Code *

Mailing Address (if different)

Agency's Phone Number *

Agency's Fax Number

Agency's website address *

CEO information

CEO's First Name *

CEO's Last Name *

CEO's Title *

CEO's Email Address *

Your definition of a "client" *

Total number of unduplicated clients served by your organization during your last fiscal year. *

Total number of unduplicated clients expected to be served by your organization in the current fiscal year. *

Percentage of Clients from Charles County *

Agency Application

United Way of Charles County is committed to investing in local programs producing measurable results to address systemic issues affecting our community.

Please complete the below form it its entirety for consideration for the 2018/2019 Community Impact Grants.

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PART I - Agency Information

Today's Date

Month

Day

Year

Agency's Name

Street Address

City

State

Zip Code

Mailing Address (if different)

Agency's Phone Number

Agency's Fax Number

Agency's website address

Number of Employees

Agency Mission Statement

Primary Contact's Information

Primary Contact's First Name

Primary Contact's Last Name

Primary Contact's Email Address

CEO information

CEO's First Name

CEO's Last Name

CEO's Title

CEO's Email Address

PART I - Agency Information

PART I - Agency Information

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