United Fund Logo
United Fund of Le Sueur, Minnesota Incorporated
P. O. Box 82
Le Sueur, MN 56058

Line-Item Funding Request Form – Year 2021

Line-Item funding requests are submitted approximately one year in advance of actual disbursement of funds. Successful applicants will receive half the funds in January and half in June.

To be included in our annual budget, organizations must submit this full application and financial disclosure. Please upload a copy of your current budget before submitting.
  - Required

  - (Optional)

  - (Optional)


Organization Name: Date:
Address: Email:
Contact Person: Phone:

Amount of Funding Requested: $

A. PROGRAM INFORMATION

Note: questions 1 through 3 and 5 through 9 have a 500 character limit
  1. What is your organization’s mission?


  2. What programs or services did your organization provide in 2018?


  3. What is your target population (age, sex, special interest, etc.)?


  4. How many people have you served in the United Fund area? (count individuals only once)
    Three years ago Two years ago This year

  5. What geographic area does your organization serve?


  6. How are your organization’s programs or services evaluated for effectiveness?


  7. What are the objectives of your organization’s programs or services?


  8. What new or different programs or services does your organization plan to provide?


  9. How will these new or different programs or services be funded?

United Fund of Le Sueur is always looking for ways to publicize the good work happening in our community. Should your project be approved would you be willing to be included in our press releases, promotional materials and other recognition opportunities?

Check this box if you agree to participate. This is optional.


B. FINANCIAL INFORMATION

1. What is your Internal Revenue Tax Exempt Number?


2. List the fund raising activities your organization has conducted the past 12 months
Activity Month/Year Conducted Geographic Area Covered Net Revenue
$
$
$
$



3. Complete the following financial summary.
2018 2019 Projected 2020
Total Revenue (all sources)
Total Expenses
Percentage of budgeted expenses for salaries and employee benefits

Please complete this math problem to show you are not a robot.
What is 4 + 3?