Daviess County Agency/Program Funding Application

Application Due Date is Friday, April 5 by 5:00 pm

Application Submission Instructions

  • Complete application on UWOV.org website and when completed hit submit. Application is due by 5pm on the stated due date. Please contact vembry@uwov.org if you have any questions or need assistance.
  • After submission of the application A PDF copy will be sent to you for your records.

Uploaded Attachments:  PLEASE NOTE UPLOADS WILL NOT BE SAVED IF YOU EXIT APPLICATION BEFORE SUBMITTING.  Application content can be saved but uploaded documents cannot.  Please upload your documents at the end of the application when you are ready to submit your completed application.

  • Please make sure you upload all required attachments. For the attachments that need to be signed, please download the form, print, get signatures, and upload the signed attachment.
  • Instructions for Financial Documents –Please upload the following:

Year End Statement of Activities (December 31 or more recent)
Statement of Financial Condition (December 31 or more recent)
Most recent 990
Audit with management letter –within six months of fiscal year close

  • Due Date: We will accept electronic version of applications until 5pm on the required due date and no later.

Cover Page/Funding Request Approval

  • Please answer each question accordingly.
  • Each agency must seek board chair and/or board approval for request of funding. There is a signature page in the upload section to download, obtain signatures, and upload. Please make sure you submit both the Program Director and the Board Chair signatures.

Response to Funding Condition / Recommendation:

Your organization would have received notification in last year’s funding letter if a funding condition or recommendation were part of the stipulation of receiving funds.

Please complete the appropriate section for a funding condition or a funding recommendation.   If you did not receive this notification, please type in N/A for not applicable and move to the next page.

 Program Financial Plan The program financial plan is designed to help each organization understand the cost of running a specific program.  By understanding, the cost associated with offering a specific program the organization can determine where and how much money they need to generate to support that one area. The organization now has data to help raise dollars, with a specific number of people served,  and the positive outcomes being produced which will provide a clear market message and aid in generating larger dollars for the program.


  • Each organization has their own definition for each of these line items. Please use your definitions to complete the financial information. It is acceptable if there are not expenses listed in a box if there are no dollars associated.
  • Please explain the difference between budget and current year if significant. We ask that you determine what is significant based on your organizations definition(s) and budget level.
  • State Funding: funds directly from the Commonwealth of Kentucky
  • Federal Funding – funds directly from Federal Government
  • In-kind: please list what in-kind revenue you track and calculate according to your own policies and procedures.  The in-kind dollars will not be a part of your total revenue line item and will not be used in the calculation for the % of UW Funds requested. This would include donated building space and costs associated, media donations, etc.


  • Please do not include in-kind expenses because in-kind revenue is not part of the calculation(s).
  • Each organization has its own definition for each of these line items. Please use your definitions to complete the financial information. It is acceptable if there are no expenses listed in a box if there are no dollars associated.
  • Salaries and benefits. Please list only the salaries that are associated with the program you are requesting funds.  If a portion of someone’s time is spent in this program then allocate the percent of salary proportionally to the time devoted to this program.  This can be 1% to 100% of the individual’s time as well as the benefits paid to the individual.
  • Program: Funds directly related to this program but not funds directly paid to or on behalf of the participant. (See next line for direct assistance to individuals).  Funds used for the entire agency would be part of the agency administration costs and not considered program costs.  (see Agency Administrative line)
  • Direct Assistance to Participants: All funds where an individual directly benefits due to them qualifying to your specific guidelines.
  • Agency Administrative: These are cost that benefit the entire agency and not just one or more programs within the organization.  This is typically a percentage of total administrative cost spread over multiple programs within your organization.

One method to calculate: The Executive Director, Administrative Assistant and Bookkeeper spends a percentage of time on board development.  Board Development is a part of the cost for every program offered within the organization.  Thus, if cost for Board Development from Executive Directors salary of $10,000 were spread across four programs then each program would be charged $2,500 in administrative costs.  The Cost of the Administrative Assistant is $4,000 spread across four programs the cost to this program would be $1,000.  The Bookkeeper cost would be $8,000 across four programs then cost to this program would be $2,000.  With the total cost of Agency Administrative Cost for this program being:  $2,500 + $1,000 + $2,000 = $5,500 for salaries / benefits for these three jobs for this program.

This process can be used for all areas including utility, technology, marketing materials, etc.

  • Agency In Direct: This is defined by your organization.  If an organization has agency in direct cost this is where it is recorded.  If you do not know this term then more than likely an Agency does not have In-Direct Expenses.  This term is primarily used for large organizations running multiple programs with several levels of leadership and areas of responsibility.

Primary and Other Beneficiary

  • Define who is your primary beneficiary for this application. This has to be tied directly to the Measurable Outcomes Form including program inputs, activities and outputs that lead to the measurable outcomes.

The Other Beneficiary column is optional to complete if you have secondary beneficiaries you track and would like to include.

For example:  if one counts primary beneficiaries as adults 25 – 54 then the outcomes need to directly relate to adults 25 – 54 and not involve their children.  If logic model surveys children between 13 – 17 years of age then please don’t count children or adults outside of this age range as a primary beneficiary.  The other children outside of the 13 -17 age range need be recorded in the other beneficiary data sheet. 

Cost Per Beneficiary:

  • Please place the total number of unduplicated individuals served within the following counties: Daviess, Hancock, McLean, Ohio, Union and Webster in the blue boxes.  You may only serve individuals in one county in which case the numbers may match the numbers directly titled “# served by County listed above”.  The percentages will be used to calculate the cost per beneficiary below to give an accurate cost per beneficiary by county.   An application must be completed for each county that you serve since demographics and beneficiary data will be different, and measurable outcomes possibly be different.  The outer counties will complete a different application for smaller funding levels.

Daviess County Agency/Program Funding Application

Step One

IMPORTANT!  The following forms must be downloaded (save to your computer to complete later) before moving to STEP 2.  The completed forms will be required to be uploaded at the end of the application process.

As part of the application process you will also be required to upload:

  • A copy of your most recent audit
  • Your most recent organizational Financial Statement or dated December 31st or later.
  • Proof of 501(c)(3) status
  • Most recent IRS 990
  • Board Roster


Step Two

Complete Grant Application Below