Program Evaluation Form Page 2
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4APPLICATION SECTION 4 – Program Staffing, Work Plan & Timeline
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A
The program is appropriately staffed with qualified service providers.
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B
Volunteers, if used, receive appropriate training and supervision.
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C
The management/supervisory structure is appropriate for the program.
Attachment F
The work plan is appropriate for implementing the program and its
D
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initiatives.
The program has a plan on how to use media to enhance
E
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communication about the program.
Subtotal (add all points for this section)
Comments:
(This field will be larger on the actual form)
APPLICATION SECTION 5 – Program Funding Request & Budget
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The United Way grant request does not exceed 50% of the program’s
X X X
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A
Attachment A
budget.
The proposed budget is appropriate for the type and quality of work
33 &
B
Attachment A
described.
The program has at least one collaborating partner, and collaborating
C
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partner(s) are providing appropriate and needed resources.
The program has a viable plan for self-sustainability after the grant
D
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period is over.
If question 37 is “No,” score=4.
If question 37 is “Yes,” the organization/program has an appropriate
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E
Attachment H
corrective action plan, and the applicant program is in good standing.
(Score should be rated between 0-3.)
Subtotal (add all points for this section)
Comments:
(This field will be larger on the actual form)
APPLICATION SECTION 6 – Program & Its Relationship to Mission
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A
The program contributes to the overall mission of the organization.
Section 1: 6
The program will actively and appropriately involve people in elected
B
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positions and other community leaders.
The program will help United Way achieve its mission to provide active
C
leadership, by bringing resources together to improve lives and create
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stronger communties.
Subtotal (add all points for this section)
Comments:
(This field will be larger on the actual form)
ORGANIZATIONAL STRUCTURE
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The agency’s Board of Directors and/or Advisory Board represents a
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diversity of skills and knowledge, including experience in finance,
Attachment G
leadership, program management and public relations.
The organization chart clearly shows the board, management and
B
Attachment F
program structure.
Based on the organization chart, the structure seems appropriate for
C
Attachment F
managing the organization and its programs.
Subtotal (add all points for this section)
Comments:
(This field will be larger on the actual form)
SUBTOTAL (All sections above; Sections 2 through 6 and Organizational Structure)
Those with an overall score of ___ and above may move forward and receive a site visit. The number of
programs that receive site visits should be determined based on the total number of applicants and the number of
applicants addressing each outcome. Only those with the highest scores should receive site visits.
Approved to move forward and receive a site visit? Yes No
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