Home
Open Menu
About Us
Staff and Officers
FAQs
Financial Documents
Partnerships
Sponsors
Resources
FamilyWize Prescription Card
Agency COVID-19 Relief Application
News & Recent Events
Get Involved
Advocate
Donate
Campaign
Donors
Register at Kroger
Support Us through AmazonSmile
Contact Us
United Way of Adams County
218 E Monroe Street, Decatur, IN 46733
ph: (260) 728-2056 | fx: (260) 728-4601
About Us
Staff and Officers
FAQs
Financial Documents
Partnerships
Sponsors
Resources
FamilyWize Prescription Card
Agency COVID-19 Relief Application
News & Recent Events
Get Involved
Advocate
Donate
Campaign
Donors
Register at Kroger
Support Us through AmazonSmile
Contact Us
Online Economic Relief Initiative Grant Application
Online Economic Relief Initiative (ERI) Grant Application
Fields marked with a
*
are required.
Organization or Agency Name:
*
Organization's Email
*
Organization's Phone
*
Organization's EIN #
*
Your First Name
*
Your Last Name
*
Title (How are you associated with the company)
*
Your Phone
*
Phone Type:
*
Cell
Land Line
Accept Texts:
*
Yes
No
Amount of Grant Request
*
Statement Of Needs
What are your emergency needs due to the coronavirus (COVID-19) pandemic? Please be specific.
*
How has the COVID restrictions affected your organization?
*
When did the concern begin? Have you maintained office hours since mid-March?
*
Statement of Spending
What results do you expect to achieve if awarded an emergency relief grant?
*
What expenses do you anticipate following the lift of COVID restrictions? Example: thermometers, sanitation gear, face masks for staff / clients, etc.
*
What more do you wish to share with the COVID Committee?
Read & Initial
I agree to account for and return any amount of the unused / unaccounted for allocation.
By checking this, I understand that I have given the Adams County Community Foundation / United Way of Adams County permission to share my application with other committees so that I may beeligiblefor assistance beyond this selection committee.
e-Sign | Person Submitting Application:
*
X