EFSP Phase 41 Application | United Way of Williams County

Agency Name

Street Address

City

State

Zip Code

Mailing Address (if different from above)

Phone

E-mail

UEI number (formerly DUNS number)

Amount Requested

A. Served Meals

B. Other Foods

C. Mass Shelter

D. Other Shelter

E. Supplies/Equipment

F. Rehabilitation/Emergency Repair

G. Rent/Mortgage

H. Utilities

Do the total of the items A-H equal the amount requested on page 1?

Board member list

Copy of current bylaws

Copy of most recent financial audit or review

Copy of most recently filed IRS Form 990

Copy of Internal Revenue Service 501(c)(3) letter

Rate and fee schedule

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