2025-2026 Impact 100 Application Form

Financials

Please upload the most recent board-approved Statement of Activities for your organization.

Mission & Brief Organization Description

Describe the mission/purpose of your organization and what your organization does. This descriptor will be used in various ways to provide context alongside the organization’s name in applicant/grantee lists.

Geographic Focus Area

Describe the geographic area served by your organization. If your organization specializes in serving a specific area—such as neighborhoods, counties, or municipalities, provide an explanation of that geographic focus. (A separate section of the proposal—the program demographics form—will collect beneficiary data by county.)

Programs and Services

Describe your organization’s top three programs and/or services. Who is the target population? What specific challenges in the lives of participants are addressed by these programs? What services are provided and how do they help achieve the intended outcomes for participants? In addition, please note any other core programs or services your organization provides that are essential to fulfilling your mission, even if they are not among the top three.

Role in the Human Service Ecosystem

Describe your organization’s role in the human service ecosystem of which it is a part. What makes your organization unique? How does it interact with other service providers and public institutions? What qualifies your organization to occupy this role? How does your organization stand out? Tell us about your organization’s successes.

Equity in Program Design and Delivery

How does your organization work to ensure equitable access to and outcomes from your programs and services? Equity can encompass race, ethnicity, income, gender, geography, disability, or other factors. Describe any strategies used in program design, delivery, and engagement with your target population. If you incorporate community or participant feedback in program design, please describe how.

Organizational Values and Inclusive Practices

Please explain how your organization ensures that programs and services are accessible and respectful to individuals of diverse backgrounds, identities, and experiences. In your response, include specific examples of how your internal policies, culture, or practices reflect these values.

Addressing Barriers to Service

Describe how your organization ensures that its services are accessible to people of all backgrounds, including those who may face barriers due to income, transportation access, cultural background, physical ability, language, immigration status, or differences based on gender, gender identity and sexual orientation.

Outcomes and Impact

Describe the outcomes that your organization’s programs help participants achieve. Describe the most important outcomes measured by your organization that demonstrate the organization’s impact in the community. Describe your organization’s success in achieving those outcomes, including data that demonstrates its success.

Total Number of people served by your Agency in a year:

Program Demographics

Please provide demographic data for participants from each of your organization’s top three programs, as previously described. You will need to complete this question separately for each program (i.e., click “Add another response” to enter three sets of data). For each program, report the number of participants in the categories listed below. If your organization does not collect unduplicated data across programs, you may provide duplicated data. Ensure that the data you provide corresponds directly to the programs you have already described.

PROGRAM NAME:

What is the Program Budget: $

Primary Focus of this Program:

2nd Additional Focus (if applicable):

3rd Additional Focus (if applicable):

Participants by County:

Jackson (KCMO portion)

E. Jackson (excluding KCMO)

Johnson (KS)

Cass (MO)

Clay (MO)

Platte (MO)

Wyandotte (KS)

Miami (KS)

Other

TOTAL

Participants by Race/Ethnicity:

American Indian/Alaska Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White

Hispanic or Latino

Middle Eastern or North African

Multiracial

Did not Identify

TOTAL

Participants by Income Level:
Please select the option that best
represents your program participants'
total household income. (If you do not
collect this data currently, please answer zero.)
For more information on Federal
Poverty Level (FPL) guidelines, click here.

Below 100% of FPL

Greater Than 100% but Below 200% of FPL

Greater Than 200% FPL

TOTAL

Participants by Age Group:

0-17

18-64

65+

Unknown

TOTAL

Additional Information:

Number of Participants who identify as LGBTQIA+

Number of Participants who identify as Military Veterans

Number of Participants who identify as having a disability

Verification

By selecting this box, I hereby certify that the organization is in compliance with all applicable local, state, and federal laws, regulations, and codes, including but not limited to, being current on IRS Form 990 filings, timely payment of payroll taxes, and adherence to all licensing requirements governing its operations. This encompasses compliance with employment laws, the Americans with Disabilities Act, and all health and safety regulations.

Please note - clicking the button below will submit your application to United Way. If you want to save your progress and resume later, please click "Save my progress and resume later" at the bottom of this screen.

	Yes	No
The organization has an accounting system and produces periodic financial statements, including a statement of activities (income and expense) and balance sheet. A recent statement of activities and balance sheet will be required with your funding proposal.
The organization has provided services to people for at least one year and within one or more of the 7-county Kansas City metro area-Jackson, Clay, Platte and Cass counties in Missouri, Johnson, Miami and Wyandotte counties in Kansas.