All United Way of Portage County Grant Review Volunteers and Co-chairs must complete this online application. This application includes basic contact information and a conflict of interest disclosure. Online applications must be submitted prior to February 1st 2017. Grant Review Volunteers will be assigned to a review panel based on their meeting availability and their conflict of interest disclosure. Assignments will be made at the discretion of United Way Board of Trustees and Staff.
Personal Contact Info
street number, city, state and zip
Work Contact Info
enter none if not applicable
Conflict of Interest
The United Way of Portage County endeavors to maintain fund distribution procedures which are fair, responsible, and free of personal bias or prejudice and which reflect the stewardship role that contributors have bestowed upon our organization.
Individuals serving in the capacity of Grant Review Volunteers enter a special relationship with both United Way and the programs currently funded by United Way. The quality of this relationship requires protection against possible conflict of interest or the appearance of conflict of interest.
Individuals or their family members who are employed by, having a contract with, or serving on the board of agencies or programs which receive United Way support will be disqualified from serving on the panel which reviews the program with which they are or have been affiliated. Thank you for your understanding in this sensitive area.
Current Conflict of Interest
Please list all agencies/organizations you, a family member or close friend currently participate in as an employee, board member, volunteer or through another close personal connection. Please separate multiple conflicts with a comma. If no conflicts exist please type none.
Past Conflicts of Interests
Please list all agencies/organizations you, a family member or close friend have participate in as an employee, board member, volunteer or through another close personal connection during the last three years. Please separate multiple conflicts with a comma. If no conflict exist enter none.
Orientation Meeting Requirement
I understand I will be required to attend an orientation meeting in early March.
Site Visits Requirement
I understand that I am required to attend Site Visits as a condition of my volunteering. I understand that site visits are currently scheduled to occur between March and April with the exact schedule to be determined with your Grant Review Panel during the Volunteer Orientation.
Final Presentation Night Availability
I understand that my availability to attend the Final Presentation Night will help to determine the review panel to which I am assigned. I understand that agency presentations are currently scheduled to occur between April 20-26, 2016 from 3-6 PM at United Way's office. Please check all dates above that you are available.
Confirmation and Agreement
Grant Review Volunteer Guide Acknowledgement
I have read, understand and agree to the expectations, requirements and responsibilities laid out in the 2017 Grant Review Volunteer Guide.
Fair and Honest Representation
I understand the requirements of fund distribution volunteers and by clicking "Yes" below I agree that this application is a fair and honest representation of myself and any conflicts of interest that might arise.