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					                                                                                               Program Budget-1                      To Be Filled in By Applicant
                                        FY13 PROGRAM BUDGET REQUEST FORM                                                             Automatically Calculates;
                                                                                                                                     Please Do Not Touch


Agency:

Program:                                                                                 Program #:                     1

                                                  Prior Yr.           Current Yr.       Proposed Yr.
                                                 2010/2011            2011/2012          2012/2013
Revenue :                                         Actual               Budget             Projected          $ Diff.        % Chg.
          1. Albemarle County                                                                                           0     0.0%
          2. City of Charlottesville                                                                                    0     0.0%
          3. Other Local Governments*                                                                                   0     0.0%
          4. United Way -Thomas Jeff. Area                                                                              0     0.0%
         5.   Albemarle County-other                                                                                    0     0.0%
         6.   City of Charlottesville-other                                                                             0     0.0%
         7.   State Funding                                                                                             0     0.0%
         8.   Federal Funding                                                                                           0     0.0%
         9.   Grants: Foundation and Corp.                                                                              0     0.0%
        10.   Fees: Program Service Fees                                                                                0     0.0%
        11.   Fundraising/Gifts and Bequests                                                                            0     0.0%
        12.   Investment Income/Transactions                                                                            0     0.0%
        13.   Miscellaneous Revenue                                                                                     0     0.0%
        14.   TOTAL REVENUE                                   0                     0                  0                0     0.0%
                                               Note: Numbers input in shaded cells automatically entered on Budget 3.
Expenses :
        15. Personnel (Salaries/Benefits)                                                                               0     0.0%
        16. Operational Expenses                                                                                        0     0.0%
        17. TOTAL EXPENSES                                    0                     0                  0                0     0.0%

        18. Surplus/(Deficit)                                 0                     0                  0                0     0.0%


Percent of Total Agency Budget :               Current Yr.              #DIV/0!         Proposed Yr. #DIV/0!

              Number of FTEs:                  Current Year _______________Proposed Yr.


* See Budget Narrative




      FY13 United Way/Local Governments Funding Application
                                                                                                                          Program Budget-2

                                                             Program Beneficiaries
                                                                  by Locality

                  Agency:           0

                  Program:          0                                                                                                  Program #:



                                                             Program Beneficiaries* by Locality
                                                                                  (Unduplicated)

Beneficiaries
                      FY10                            FY11                             FY12                           FY13          # Diff. (13 Proj-
by Locality :       Projected       FY10 Actual     Projected       FY11 Actual      Projected       FY12 Revised   Projected           12 Rev)         %
Albemarle                                                                                                                                           0   0.0%
Charlottesville                                                                                                                                     0   0.0%
Other                                                                                                                                               0   0.0%

Total                           0              0                0              0                 0             0                0                  0    0.0%



                  * Primary or direct beneficiary of service as defined by the agency. Secondary or indirect
                    beneficiaries are not included in this count.

                  Explanation




        FY13 United Way/Local Governments Funding Application
                                                                                     Program Budget- 3

                              Program Budget - Significant Differences Explanation

1.        Explain any significant revenue/expenditure line item increase or decrease as shown on PB-1 Program Budget.

                                                     %
Revenue :                                  $ Diff. Change          Explanation
     1.   Albemarle County                        0      0.00%
     2.   City of Charlottesville                 0      0.00%
     3.   Other Local Governments                 0      0.00%
     4.   United Way -Thomas Jeff. Area           0      0.00%
     5.   Albemarle County-other                  0      0.00%
     6.   City of Charlottesville-other           0      0.00%
     7.   State Funding                           0      0.00%
     8.   Federal Funding                         0      0.00%
  9.      Grants: Foundation and Corp.            0      0.00%
 10.      Fees: Program Service Fees              0      0.00%
 11.      Fundraising/Gifts and Bequests          0      0.00%
 12.      Investment Income/Transactions          0      0.00%
 13.      Miscellaneous Revenue                   0      0.00%
 14.      TOTAL REVENUE                           0      0.00%

Expenses :
 15. Personnel (Salaries/Benefits)                0      0.00%
 16. Operational Expenses                         0      0.00%
 17. TOTAL EXPENSES                               0      0.00%

 18.      Surplus/(Deficit)                       0      0.00%




            FY13 United Way/Local Governments Funding Application
                                                                                                Program Budget-1

                                      FY13 PROGRAM BUDGET REQUEST FORM


Agency:                                    0


Program:                                                                                  Program #:                    2

                                                  Prior Yr.           Current Yr.        Proposed Yr.
                                                 2010/2011            2011/2012           2012/2013
Revenue :                                         Actual               Budget              Projected          $ Diff.       % Chg.
        1. Albemarle County                                                                                             0     0.0%
        2. City of Charlottesville                                                                                      0     0.0%
        3. Other Local Governments*                                                                                     0     0.0%
        4. United Way -Thomas Jeff. Area                                                                                0     0.0%
        5.   Albemarle County-other                                                                                     0     0.0%
        6.   City of Charlottesville-other                                                                              0     0.0%
        7.   State Funding                                                                                              0     0.0%
        8.   Federal Funding                                                                                            0     0.0%
        9.   Grants: Foundation and Corp.                                                                               0     0.0%
       10.   Fees: Program Service Fees                                                                                 0     0.0%
       11.   Fundraising/Gifts and Bequests                                                                             0     0.0%
       12.   Investment Income/Transactions                                                                             0     0.0%
       13.   Miscellaneous Revenue                                                                                      0     0.0%
       14.   TOTAL REVENUE                                    0                      0                   0              0     0.0%
                                               Note: Numbers input in shaded cells automatically entered on Budget 3.
Expenses :
       15. Personnel (Salaries/Benefits)                                                                                0     0.0%
       16. Operational Expenses                                                                                         0     0.0%
       17. TOTAL EXPENSES                                     0                      0                   0              0     0.0%

       18. Surplus/(Deficit)                                  0                      0                   0              0     0.0%


Percent of Total Agency Budget :               Current Yr.               #DIV/0!         Proposed Yr. #DIV/0!

             Number of FTEs:                   Current Year _______________Proposed Yr.



* See Budget Narrative




     FY11 United Way/Local Governments Funding Application
                                                                                                                          Program Budget-2

                                                             Program Beneficiaries
                                                                  by Locality

                  Agency:           0

                  Program:          0                                                                                                  Program #:



                                                             Program Beneficiaries* by Locality
                                                                                  (Unduplicated)

Beneficiaries
                      FY10                            FY11                             FY12                           FY13          # Diff. (13 Proj-
by Locality :       Projected       FY10 Actual     Projected       FY11 Actual      Projected       FY12 Revised   Projected           12 Rev)         %
Albemarle                                                                                                                                           0   0.0%
Charlottesville                                                                                                                                     0   0.0%
Other                                                                                                                                               0   0.0%

Total                           0              0                0              0                 0             0                0                  0    0.0%



                  * Primary or direct beneficiary of service as defined by the agency. Secondary or indirect
                    beneficiaries are not included in this count.


                  Explanation




        FY11 United Way/Local Governments Funding Application
                                                                                   Program Budget- 3

                            Program Budget - Significant Differences Explanation

1.      Explain any significant revenue/expenditure line item increase or decrease as shown on PB-1 Program Budget.

                                                   %
Revenue :                                $ Diff. Change          Explanation
     1. Albemarle County                        0       0.00%
     2. City of Charlottesville                 0       0.00%

     3. Other Local Governments                 0       0.00%
     4. United Way -Thomas Jeff. Area           0       0.00%
     5. Albemarle County-other                  0       0.00%
     6. City of Charlottesville-other           0       0.00%
     7. State Funding                           0       0.00%
     8. Federal Funding                         0       0.00%
  9. Grants: Foundation and Corp.               0       0.00%
 10. Fees: Program Service Fees                 0       0.00%
 11. Fundraising/Gifts and Bequests             0       0.00%
 12. Investment Income/Transactions             0       0.00%
 13. Miscellaneous Revenue                      0       0.00%
 14. TOTAL REVENUE                              0       0.00%


Expenses :
 15. Personnel (Salaries/Benefits)              0       0.00%
 16. Operational Expenses                       0       0.00%
 17. TOTAL EXPENSES                             0       0.00%


 18. Surplus/(Deficit)                          0       0.00%




           FY11 United Way/Local Governments Funding Application
                                                                                                  Program Budget-1

                                     FY13 PROGRAM BUDGET REQUEST FORM


Agency:                                      0


Program:                                                                                    Program #:                    3

                                                    Prior Yr.           Current Yr.        Proposed Yr.
                                                   2010/2011            2011/2012           2012/2013
Revenue :                                           Actual               Budget              Projected          $ Diff.       % Chg.
       1. Albemarle County                                                                                                0     0.0%
       2. City of Charlottesville                                                                                         0     0.0%
       3. Other Local Governments*                                                                                        0     0.0%
       4. United Way -Thomas Jeff. Area                                                                                   0     0.0%
       5.   Albemarle County-other                                                                                        0     0.0%
       6.   City of Charlottesville-other                                                                                 0     0.0%
       7.   State Funding                                                                                                 0     0.0%
       8.   Federal Funding                                                                                               0     0.0%
       9.   Grants: Foundation and Corp.                                                                                  0     0.0%
      10.   Fees: Program Service Fees                                                                                    0     0.0%
      11.   Fundraising/Gifts and Bequests                                                                                0     0.0%
      12.   Investment Income/Transactions                                                                                0     0.0%
      13.   Miscellaneous Revenue                                                                                         0     0.0%
      14.   TOTAL REVENUE                                       0                      0                   0              0     0.0%
                                                 Note: Numbers input in shaded cells automatically entered on Budget 3.
Expenses :
      15. Personnel (Salaries/Benefits)                                                                                   0     0.0%
      16. Operational Expenses                                                                                            0     0.0%
      17. TOTAL EXPENSES                                        0                      0                   0              0     0.0%

      18. Surplus/(Deficit)                                     0                      0                   0              0     0.0%


Percent of Total Agency Budget :                 Current Yr.               #DIV/0!          Proposed Yr. #DIV/0!

            Number of FTEs:                      Current Year _______________Proposed Yr.




            * See budget narrative




     FY11 United Way/Local Governments Funding Application
                                                                                                                          Program Budget-2

                                                             Program Beneficiaries
                                                                  by Locality

                  Agency:           0

                  Program:          0                                                                                                  Program #:



                                                             Program Beneficiaries* by Locality
                                                                                  (Unduplicated)

Beneficiaries
                      FY10                            FY11                             FY12                           FY13          # Diff. (13 Proj-
by Locality :       Projected       FY10 Actual     Projected       FY11 Actual      Projected       FY12 Revised   Projected           12 Rev)         %
Albemarle                                                                                                                                           0   0.0%
Charlottesville                                                                                                                                     0   0.0%
Other                                                                                                                                               0   0.0%

Total                           0              0                0              0                 0             0                0                  0    0.0%



                  * Primary or direct beneficiary of service as defined by the agency. Secondary or indirect
                    beneficiaries are not included in this count.


                  Explanation




        FY11 United Way/Local Governments Funding Application
                                                                                   Program Budget- 3

                            Program Budget - Significant Differences Explanation

1.      Explain any significant revenue/expenditure line item increase or decrease as shown on PB-1 Program Budget.

                                                   %
Revenue :                                $ Diff. Change          Explanation
     1. Albemarle County                        0       0.00%
     2. City of Charlottesville                 0       0.00%

     3. Other Local Governments                 0       0.00%
     4. United Way -Thomas Jeff. Area           0       0.00%
     5. Albemarle County-other                  0       0.00%
     6. City of Charlottesville-other           0       0.00%
     7. State Funding                           0       0.00%
     8. Federal Funding                         0       0.00%
  9. Grants: Foundation and Corp.               0       0.00%
 10. Fees: Program Service Fees                 0       0.00%
 11. Fundraising/Gifts and Bequests             0       0.00%
 12. Investment Income/Transactions             0       0.00%
 13. Miscellaneous Revenue                      0       0.00%
 14. TOTAL REVENUE                              0       0.00%


Expenses :
 15. Personnel (Salaries/Benefits)              0       0.00%
 16. Operational Expenses                       0       0.00%
 17. TOTAL EXPENSES                             0       0.00%


 18. Surplus/(Deficit)                          0       0.00%




           FY11 United Way/Local Governments Funding Application
                                                                                                  Program Budget-1

                                     FY13 PROGRAM BUDGET REQUEST FORM


Agency:                                      0


Program:                                                                                    Program #:                    4

                                                    Prior Yr.           Current Yr.        Proposed Yr.
                                                   2010/2011            2011/2012           2012/2013
Revenue :                                           Actual               Budget              Projected          $ Diff.       % Chg.
       1. Albemarle County                                                                                                0     0.0%
       2. City of Charlottesville                                                                                         0     0.0%
       3. Other Local Governments*                                                                                        0     0.0%
       4. United Way -Thomas Jeff. Area                                                                                   0     0.0%
       5.   Albemarle County-other                                                                                        0     0.0%
       6.   City of Charlottesville-other                                                                                 0     0.0%
       7.   State Funding                                                                                                 0     0.0%
       8.   Federal Funding                                                                                               0     0.0%
       9.   Grants: Foundation and Corp.                                                                                  0     0.0%
      10.   Fees: Program Service Fees                                                                                    0     0.0%
      11.   Fundraising/Gifts and Bequests                                                                                0     0.0%
      12.   Investment Income/Transactions                                                                                0     0.0%
      13.   Miscellaneous Revenue                                                                                         0     0.0%
      14.   TOTAL REVENUE                                       0                      0                   0              0     0.0%
                                                 Note: Numbers input in shaded cells automatically entered on Budget 3.
Expenses :
      15. Personnel (Salaries/Benefits)                                                                                   0     0.0%
      16. Operational Expenses                                                                                            0     0.0%
      17. TOTAL EXPENSES                                        0                      0                   0              0     0.0%

      18. Surplus/(Deficit)                                     0                      0                   0              0     0.0%


Percent of Total Agency Budget :                 Current Yr.               #DIV/0!          Proposed Yr. #DIV/0!

            Number of FTEs:                      Current Year _______________Proposed Yr.


            * See Budget Narrative




     FY11 United Way/Local Governments Funding Application
                                                                                                                          Program Budget-2

                                                             Program Beneficiaries
                                                                  by Locality

                  Agency:                      0

                  Program:                     0                                                                                       Program #:



                                                             Program Beneficiaries* by Locality
                                                                                  (Unduplicated)

Beneficiaries
                      FY10                            FY11                             FY12                           FY13          # Diff. (13 Proj-
by Locality :       Projected       FY10 Actual     Projected       FY11 Actual      Projected       FY12 Revised   Projected           12 Rev)         %
Albemarle                                                                                                                                           0   0.0%
Charlottesville                                                                                                                                     0   0.0%
Other                                                                                                                                               0   0.0%

Total                           0              0                0              0                 0             0                0                  0    0.0%



                  * Primary or direct beneficiary of service as defined by the agency. Secondary or indirect
                    beneficiaries are not included in this count.

                  Explanation




        FY11 United Way/Local Governments Funding Application
                                                                                   Program Budget- 3

                            Program Budget - Significant Differences Explanation

1.      Explain any significant revenue/expenditure line item increase or decrease as shown on PB-1 Program Budget.

                                                   %
Revenue :                                $ Diff. Change          Explanation
     1. Albemarle County                        0       0.00%
     2. City of Charlottesville                 0       0.00%

     3. Other Local Governments                 0       0.00%
     4. United Way -Thomas Jeff. Area           0       0.00%
     5. Albemarle County-other                  0       0.00%
     6. City of Charlottesville-other           0       0.00%
     7. State Funding                           0       0.00%
     8. Federal Funding                         0       0.00%
  9. Grants: Foundation and Corp.               0       0.00%
 10. Fees: Program Service Fees                 0       0.00%
 11. Fundraising/Gifts and Bequests             0       0.00%
 12. Investment Income/Transactions             0       0.00%
 13. Miscellaneous Revenue                      0       0.00%
 14. TOTAL REVENUE                              0       0.00%


Expenses :
 15. Personnel (Salaries/Benefits)              0       0.00%
 16. Operational Expenses                       0       0.00%
 17. TOTAL EXPENSES                             0       0.00%


 18. Surplus/(Deficit)                          0       0.00%




           FY11 United Way/Local Governments Funding Application
                                                                                                  Program Budget-1

                                     FY13 PROGRAM BUDGET REQUEST FORM


Agency:                                      0


Program:                                                                                    Program #:                    5

                                                    Prior Yr.           Current Yr.        Proposed Yr.
                                                   2010/2011            2011/2012           2012/2013
Revenue :                                           Actual               Budget              Projected          $ Diff.       % Chg.
       1. Albemarle County                                                                                                0     0.0%
       2. City of Charlottesville                                                                                         0     0.0%
       3. Other Local Governments*                                                                                        0     0.0%
       4. United Way -Thomas Jeff. Area                                                                                   0     0.0%
       5.   Albemarle County-other                                                                                        0     0.0%
       6.   City of Charlottesville-other                                                                                 0     0.0%
       7.   State Funding                                                                                                 0     0.0%
       8.   Federal Funding                                                                                               0     0.0%
       9.   Grants: Foundation and Corp.                                                                                  0     0.0%
      10.   Fees: Program Service Fees                                                                                    0     0.0%
      11.   Fundraising/Gifts and Bequests                                                                                0     0.0%
      12.   Investment Income/Transactions                                                                                0     0.0%
      13.   Miscellaneous Revenue                                                                                         0     0.0%
      14.   TOTAL REVENUE                                       0                      0                   0              0     0.0%
                                                 Note: Numbers input in shaded cells automatically entered on Budget 3.
Expenses :
      15. Personnel (Salaries/Benefits)                                                                                   0     0.0%
      16. Operational Expenses                                                                                            0     0.0%
      17. TOTAL EXPENSES                                        0                      0                   0              0     0.0%

      18. Surplus/(Deficit)                                     0                      0                   0              0     0.0%


Percent of Total Agency Budget :                 Current Yr.               #DIV/0!          Proposed Yr. #DIV/0!

            Number of FTEs:                      Current Year _______________Proposed Yr.


            * See Budget Narrative




     FY11 United Way/Local Governments Funding Application
                                                                                                                          Program Budget-2

                                                             Program Beneficiaries
                                                                  by Locality

                  Agency:           0

                  Program:          0                                                                                                  Program #:



                                                             Program Beneficiaries* by Locality
                                                                                  (Unduplicated)

Beneficiaries
                      FY10                            FY11                             FY12                           FY13          # Diff. (13 Proj-
by Locality :       Projected       FY10 Actual     Projected       FY11 Actual      Projected       FY12 Revised   Projected           12 Rev)         %
Albemarle                                                                                                                                           0   0.0%
Charlottesville                                                                                                                                     0   0.0%
Other                                                                                                                                               0   0.0%

Total                           0              0                0              0                 0             0                0                  0    0.0%



                  * Primary or direct beneficiary of service as defined by the agency. Secondary or indirect
                    beneficiaries are not included in this count.

                  Explanation




        FY11 United Way/Local Governments Funding Application
                                                                                   Program Budget- 3

                            Program Budget - Significant Differences Explanation

1.      Explain any significant revenue/expenditure line item increase or decrease as shown on PB-1 Program Budget.

                                                   %
Revenue :                                $ Diff. Change          Explanation
     1. Albemarle County                        0       0.00%
     2. City of Charlottesville                 0       0.00%

     3. Other Local Governments                 0       0.00%
     4. United Way -Thomas Jeff. Area           0       0.00%
     5. Albemarle County-other                  0       0.00%
     6. City of Charlottesville-other           0       0.00%
     7. State Funding                           0       0.00%
     8. Federal Funding                         0       0.00%
  9. Grants: Foundation and Corp.               0       0.00%
 10. Fees: Program Service Fees                 0       0.00%
 11. Fundraising/Gifts and Bequests             0       0.00%
 12. Investment Income/Transactions             0       0.00%
 13. Miscellaneous Revenue                      0       0.00%
 14. TOTAL REVENUE                              0       0.00%


Expenses :
 15. Personnel (Salaries/Benefits)              0       0.00%
 16. Operational Expenses                       0       0.00%
 17. TOTAL EXPENSES                             0       0.00%


 18. Surplus/(Deficit)                          0       0.00%




           FY11 United Way/Local Governments Funding Application
                                                                                                 Program Budget-1

                                     FY13 PROGRAM BUDGET REQUEST FORM


Agency:                                      0


Program:                                                                                   Program #:                     6

                                                    Prior Yr.           Current Yr.       Proposed Yr.
                                                   2010/2011            2011/2012          2012/2013
Revenue :                                           Actual               Budget             Projected          $ Diff.        % Chg.
       1. Albemarle County                                                                                                0     0.0%
       2. City of Charlottesville                                                                                         0     0.0%
       3. Other Local Governments*                                                                                        0     0.0%
       4. United Way -Thomas Jeff. Area                                                                                   0     0.0%
       5.   Albemarle County-other                                                                                        0     0.0%
       6.   City of Charlottesville-other                                                                                 0     0.0%
       7.   State Funding                                                                                                 0     0.0%
       8.   Federal Funding                                                                                               0     0.0%
       9.   Grants: Foundation and Corp.                                                                                  0     0.0%
      10.   Fees: Program Service Fees                                                                                    0     0.0%
      11.   Fundraising/Gifts and Bequests                                                                                0     0.0%
      12.   Investment Income/Transactions                                                                                0     0.0%
      13.   Miscellaneous Revenue                                                                                         0     0.0%
      14.   TOTAL REVENUE                                       0                     0                   0               0     0.0%
                                                 Note: Numbers input in shaded cells automatically entered on Budget 3.
Expenses :
      15. Personnel (Salaries/Benefits)                                                                                   0     0.0%
      16. Operational Expenses                                                                                            0     0.0%
      17. TOTAL EXPENSES                                        0                     0                   0               0     0.0%

      18. Surplus/(Deficit)                                     0                     0                   0               0     0.0%


Percent of Total Agency Budget :                 Current Yr.              #DIV/0!          Proposed Yr.       #DIV/0!

            Number of FTEs:                      Current Year _______________Proposed Yr.


            * See Budget Narrative
                                                                                                                   Pr

                                                            Program Beneficiaries
                                                                 by Locality

                  Agency:           0

                  Program:          0




                                                            Program Beneficiaries* by Locality
                                                                               (Unduplicated)

Beneficiaries
                      FY10                           FY11                            FY12
by Locality :       Projected       FY10 Actual    Projected       FY11 Actual     Projected       FY12 Revised
Albemarle
Charlottesville
Other

Total                           0              0               0               0               0               0




                  * Primary or direct beneficiary of service as defined by the agency. Secondary or indirect
                    beneficiaries are not included in this count.

                  Explanation
                   Program Budget-2




                                Program #:



y Locality



               FY13          # Diff. (13 Proj-
             Projected           12 Rev)         %
                                             0    0.0%
                                             0    0.0%
                                             0    0.0%

                         0                  0    0.0%
                            Program Budget - Significant Differences Explanation

1.      Explain any significant revenue/expenditure line item increase or decrease as shown on PB-1 Program Budget.

                                                   %
Revenue :                                $ Diff. Change
     1. Albemarle County                         0      0.00%
     2. City of Charlottesville                  0      0.00%

     3. Other Local Governments                  0      0.00%
     4. United Way -Thomas Jeff. Area            0      0.00%
     5. Albemarle County-other                   0      0.00%
     6. City of Charlottesville-other            0      0.00%
     7. State Funding                            0      0.00%
     8. Federal Funding                          0      0.00%
  9. Grants: Foundation and Corp.                0      0.00%
 10. Fees: Program Service Fees                  0      0.00%
 11. Fundraising/Gifts and Bequests              0      0.00%
 12. Investment Income/Transactions              0      0.00%
 13. Miscellaneous Revenue                       0      0.00%
 14. TOTAL REVENUE                               0      0.00%


Expenses :
 15. Personnel (Salaries/Benefits)               0      0.00%
 16. Operational Expenses                        0      0.00%
 17. TOTAL EXPENSES                              0      0.00%


 18. Surplus/(Deficit)                           0      0.00%
                           Program Budget- 3

gnificant Differences Explanation

item increase or decrease as shown on PB-1 Program Budget.



           Explanation
This information will calculate automatically based on the programs for which you are requesting City/County/United Way
funding plus other revenues and expenditures


                                                         Total Agency                                             Total
                                                Revenue and Expense Report                                      Budget-1


Agency:                                     0


                                                   Prior Yr.           Current Yr.          Proposed Yr.
                                                  2010/2011            2011/2012             2012/2013
Revenue :                                          Actual               Budget                Projected          $ Diff.        % Chg.
      1.   Albemarle County                                                                                                 0       0.0%
      2.   City of Charlottesville                                                                                          0       0.0%
      3.   Other Local Governments                                                                                          0       0.0%
      4.   United Way -Thomas Jeff. Area                                                                                    0       0.0%
      5.   Albemarle County-other                                                                                           0       0.0%
      6.   City of Charlottesville-other                                                                                    0       0.0%
      7.   State Funding                                                                                                    0       0.0%
      8.   Federal Funding                                                                                                  0       0.0%
      9.   Grants: Foundation and Corp.                                                                                     0       0.0%
     10.   Fees: Program Service Fees                                                                                       0       0.0%
     11.   Fundraising/Gifts and Bequests                                                                                   0       0.0%
     12.   Investment Income/Transactions                                                                                   0       0.0%
     13.   Miscellaneous Revenue                                                                                            0       0.0%
     14.   TOTAL REVENUE                                       0                      0                    0                0       0.0%
                                                Note: Numbers input in shaded cells automatically entered on Agency Beneficiaries.
Expenses :
     15. Personnel (Salaries/Fringes)                                                                                       0        0.0%
     16. Operational Expenses                                                                                               0        0.0%
     17. TOTAL EXPENSES                                        0                      0                    0                0        0.0%

     18. Surplus/(Deficit) *                                   0                      0                    0                0        0.0%
 *       Explain any Surplus or Deficit:

           Number of FTE's                      Current year: _____________                Proposed year


           30:   Capital/reserve revenues                                                                                   0        0.0%
           31.   Capital expenses                                                                                           0        0.0%
           32.   Reserve Expenses                                                                                           0        0.0%
           33.   Capital/reserve balance                        0                      0                    0                        0.0%




       FY11 United Way/Local Governments Funding Application
                                                                                                               Total Program Beneficiaries
                                                    Total Beneficiaries for
                                                           All Programs in Application
                                                                                (this form does not calculate automatically)


                  Agency:                    0




                                                      Total Beneficiaries* by Locality
                                                                         (Unduplicated)

                                                                                                                              # Diff. (13
                      FY10                          FY11                           FY12           FY12            FY13         Proj-12
by Locality :       Projected       FY10 Actual   Projected       FY11 Actual    Projected       Revised        Projected       Rev)        %
Albemarle                       0             0               0             0                0             0                0           0   0.0%
Charlottesville                 0             0               0             0                0             0                0           0   0.0%
Other                           0             0               0             0                0             0                0           0   0.0%

Total                           0            0                0            0                 0             0                0          0     0.0%




                  * Primary or direct beneficiaries of services as defined by the agency. Secondary or indirect
                    beneficiaries are not included in this count.




        FY11 United Way/Local Governments Funding Application

				
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