Agency Application | United Way of Muskingum, Perry & Morgan Counties

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Part 2 - Program Information
Part 3 - Uploads & Submission
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PART I - Agency Information

Agency Information

Agency's Name

Agency's Address

Address

City

State

ZIP Code

Mailing Address (if different)

Address

City

State

ZIP Code

Agency's Phone Number

Agency's Fax Number

Number of Employees

Agency's Web Address

Agency Mission Statement

Primary Contact Information

Primary Contact First Name

Primary Contact Last Name

Primary Contact E-Mail Address

Primary Contact Phone

CEO Contact Information

CEO First Name

CEO Last Name

CEO E-Mail

CEO Phone

Fundraising and Administration

The percent of fundraising and administration must be completed from the information on the IRS Form 990 by adding the amount spent on "management and general" (Part IX, Column C, Line 25) to the "amount spent on fundraising" (Part IX, Column D, Line 25) and dividing the result by "total revenue" (Part 1, line 12).
Please only enter numbers - NO $ or commas.

Management and General Total (Part IX, Column C, Line 25) $

PLUS

Amount Spent on Fundraising (Part IX, Column D, Line 25) $

DIVIDED BY

Total Revenue (Part 1, Line 12) $

Percent of Administration and fundraising NAN%

If percent of fundraising and administration is over 25%, please explain: