Give 5 Nonprofit Application Form

Organization:

Nonprofit Name: REQUIRED Please fill out this field. Please enter valid data.

Address: REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

The address where Give 5 class will tour: Same as above?

Or, to the following:

Is your organization in Taney or Stone County? REQUIRED Taney County Stone County Please fill out this field.

Executive Director:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Title: REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Volunteer Coordinator:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Title: REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Alignment with Community Priorities

It is our intention to focus the Give 5 program toward nonprofits whose mission aligns most closely with the following community priorities. Please indicate which of the following community priorities your organization aligns (select all that apply):

Community Priorities your Organization Aligns REQUIRED Children's Services Digital Divide (providing internet connectivity and tech literacy) Food Access and Nutrition Healthcare and Wellness (inadequate access to healthcare, uninsured) Housing (environmental threats) Jobs and Economic Development Public Safety/Transportation Educational Inequalities/Mentorship Mental Health Please fill out this field.

Note: It is possible that, if the Give 5 program is successful, additional “tracks” could be created that are focused on other priorities in addition to the ones listed above.

Alignment with Community Priorities

If your organization is selected to participate in the Give 5 program, a representative from Give 5 will work with you to outline your intended “hosting time” when each Give 5 class is delivered to your organization. Your organization will likely have 45 minutes with each class. The class size will be no more than 20 members. It is our intention that your “hosting time” be informative, engaging and, if possible, interactive. We encourage you not to place the class in a room and “talk at them.” This is your organization’s opportunity to put your best foot forward to explain what you do and any volunteer opportunities you have that might appeal to the class members.

Approximately how many volunteers does your organization have now? REQUIRED Please fill out this field. Please enter valid data.

How many additional volunteers can your organization accommodate? REQUIRED Please fill out this field. Please enter valid data.

Volunteer Skills/Talents

What special skills/talents are you seeking in your volunteers, and approximately how many hours per month (i.e. 5-10 hours per month) are you needing volunteers in each skill/talent category?

Board Service

Yes Please select this field.
Hours per Month Please enter valid data.

Business

Yes Please select this field.
Hours per Month Please enter valid data.

Clerical/Office Work

Yes Please select this field.
Hours per Month Please enter valid data.

Education/Teaching

Yes Please select this field.
Hours per Month Please enter valid data.

Financial

Yes Please select this field.
Hours per Month Please enter valid data.

Healthcare/Medical

Yes Please select this field.
Hours per Month Please enter valid data.

Labor

Yes Please select this field.
Hours per Month Please enter valid data.

Leadership

Yes Please select this field.
Hours per Month Please enter valid data.

Legal

Yes Please select this field.
Hours per Month Please enter valid data.

Marketing/Public Relations

Yes Please select this field.
Hours per Month Please enter valid data.

Mentorship

Yes Please select this field.
Hours per Month Please enter valid data.

Technology

Yes Please select this field.
Hours per Month Please enter valid data.

Other

Yes Please select this field.
Other Skill/Talent Please enter valid data.
Hours per Month Please enter valid data.

Other

Yes Please select this field.
Other Skill/Talent Please enter valid data.
Hours per Month Please enter valid data.

Within the list above, which three are your organization's areas of greatest need: REQUIRED Please fill out this field.

The Process

All members of each class will be provided a binder of information about each of the nonprofit organizations they will be visiting.

Do we have your permission to include in the binder any information you provide on this form? REQUIRED Yes No Please fill out this field.

If selected to participate, your organization’s executive director and volunteer coordinator will be emailed a document providing summary demographic information about the class that will be visiting. This document will not include personal information about the members of the class, but summary information will be provided.

It is our intention to track the effectiveness of the Give 5 program over time. Selected non-profits will be asked to provide statistical information (number of volunteer hours worked per Give 5 volunteer) and a brief anecdotal report via email every six months.

If selected, does your organization commit to providing this information every six months? REQUIRED Yes No Please fill out this field.

Application Signature

Via my signature below, my organization is applying to participate in the Give 5 program with United Way.

Executive Director Name REQUIRED Please fill out this field. Please enter valid data.

In lieu of a digital signature, please select "Application Signed" to complete your application. REQUIRED Application Signed by the Executive Director Please fill out this field.

Signature Date: REQUIRED Please fill out this field. Please enter a date.