United Way of Hays County
Phone: 512.353.1420
Fax: 512.353.1421
Email: [email protected]
Mailing address:
United Way of Hays County P.O. Box 1728
San Marcos, Texas 78667-6860
United Way of Hays County
2015 Flood Relief Fund
Thank you for your interest in applying for funds from the United Way of Hays County 2015 Flood Relief
Fund. The United Way of Hays County board of directors established the 2015 Flood Relief Fund on May
25 to benefit partners our agencies and other organizations that are providing direct assistance to flood
victims throughout Hays and Caldwell Counties in the wake of the devastating Memorial Day Weekend
Flood. We are thankful for the hundreds of individuals, organizations, businesses, musicians and others
who have donated to this fund. 100 percent of donations will be distributed to benefit Hays and Caldwell
flood relief efforts. No funding will be held for overhead or administration.
Priorities for immediate disbursal of funds are to fund agencies and organizations who are assisting flood
survivors who have immediate housing needs, focusing on survivors with no flood insurance, and
initiatives that support the elderly, children, disabled and single household families. These priorities will
be updated as conditions change.
We look forward to working with local and regional agencies providing long-term disaster relief to Hays
and Caldwell County flood survivors.
If at any time, you find you have questions, please do not hesitate to contact me. Thank you again for your
interest in partnering with United Way in meeting the needs of our neighbors affected by the flooding.
Michelle Harper
President/CEO
2015 United Way of Hays County Flood Relief Application
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2015 Flood Relief Application
Agency/Organization Name:
Program:
What is your Program’s Mission and Purpose?
Indicate United Way 2015 Flood Relief Fund Priority Area most related to your program: Immediate
housing needs, focusing on survivors with no flood insurance, and initiatives that support the
elderly, children, disabled and single household families.
Address:
Contact Person
Phone No:
Email Address:
FED TAX ID #
Please indicate the Fiscal/Calendar year end for
your most recent filing of the IRS Form 990/990
EZ/990 N:
Amount Requested: $
Purpose of United Way Funds: (please attach additional documentation if needed)
2015 United Way of Hays County Flood Relief Application
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2015 Program Funding Request: Briefly describe your request, including how dollars will be spent.
Signature
Title:
United Way Staff Contact: Michelle Harper
Telephone: 512.353.1420
Email: [email protected]
Date:
For Office Use Only:
Date received: ___________
GENERAL INFORMATION
1. Specific services that you will provide for flood relief.
2. Who and how many individuals will be served by your organization:
3. Outcomes you hope to accomplish with this funding:
4. How you will measure your success:
5. BRIEFLY Describe examples of how your program collaborates with other organizations in the
community, particularly other United Way funded programs.
Success Story: Please provide one (1) example of how this program helped someone in the past
12 months. This story may be used in marketing to demonstrate how United Way donations are utilized.
2015 United Way of Hays County Flood Relief Application
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Memorandum of Understanding Agreement between
United Way of Hays County
(hereinafter referred to as United Way)
And
_______________________
(hereinafter referred to as the Agency)
for emergency flood relief allocation 2015
The signing of this agreement will allow the release of allocated dollars, if awarded, for the coming year.
United Way of Hays County and the Agency enter into this agreement in order to:
It is the mutual objective of United Way of Hays County and agencies that the optimal amount of money
be made available for the provision of emergency flood relief in our area.
It is agreed that United Way:
1. Will pay the allocation in full.
2. Recognizes the right of the Agency to determine its programs and services, its policies of operation
and to administer its own internal affairs.
3. Will, in cooperation with the Agency, direct its own public relations and marketing efforts so as to
assist the Agency with the educational campaign of its funded programs. United Way will publicize
its affairs and those of the Agency’s supported programs as widely as possible.
It is agreed that the Agency:
1. Agrees to participate in United Way’s review process and provide necessary documentation within
60 days of allocation of funds via UWHC Flood Relief Fund Report of Spending.
2. Agrees to maintain responsible management, including a Board of Directors and an Executive
Director, or a like position.
3. Agrees to cooperate with other human service agencies, both public and private, in preventing
duplication of efforts and in promoting efficiency and economy of administration of services.
4. Agrees to participate in meetings with UWHC and other organizations to prevent duplication of
efforts and to promote efficiency.
5. Agrees to report to United Way any major program/budget changes that may affect how United
Way allocated dollars are spent.
6. Agrees to mention its participation as a United Way partner in news releases, media programs,
brochures, etc. where United Way dollars are a part of the program or service, and in verbal
presentations where appropriate.
2015 United Way of Hays County Flood Relief Application
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7. Will return to United Way any funds allocated to the Agency that may no longer be used for their
intended purposes, where by any act or default on the part of the Agency, or by an operation or
process of law, or by any means whatsoever.
8. Will refrain from taking actions or conducting activities likely to damage the reputation of United
Way. All concerns must be directed immediately to a United Way representative.
Signed this___________ day of _____________________, ______
Agency:
_________________________________________________________
Chief Volunteer Board Officer
_________________________________________________________
Chief Professional Officer
United Way of Hays County:
_________________________________________________________
United Way of Hays County, Board Chairman
Kim Porterfield
_________________________________________________________
United Way of Hays County, President/CEO
Michelle Harper
2015 United Way of Hays County Flood Relief Application
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