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2. 

3. Newton County Fiscal Year 2024 External Appropriation Application

5. Agency Name: *
7. Contact Person: *
9. Address*
11. City*
12. State*
13. Zip Code
15. Phone Number*
17. Email Address*

19. Please provide the information requested below no later than Feb.1, 2023. If you have additional information you would like the County to consider, please feel free to send to blwhite@co.newton.ga.us, subject line Appropriation.

21. 1. Amount requested for Fiscal Year 2024 *Max $2,500*: *
23. 2. What percentage of your overall budget does the requested amount represent?*

25. 3. Please list your primary funding sources other than the County and the percentage of your budget they represent:

27. Funding Source*
28. % of Budget the Source Represents*
30. Funding Source*
31. % of Budget the Source Represents*
33. Funding Source*
34. % of Budget the Source Represents*
36. 4. Check this box if you received funding from Newton County in the past.

    1. Yes, I have received funding from Newton County
38. If so, please indicate how much funding each year for the past three fiscal years.

    Enter amount for past three fiscal years.

40. 5. How would your program or project be impacted if it did not receive funding from Newton County or if funding from Newton County were reduced?*

    Please describe the potential impact in detail.

42. 6. Please provide a brief description of your operational/business functions.*

    Please describe your business here.

44. 7. Check this box if your program or project have a strategic plan or business plan in place.

    1. Yes, there is a plan in place
46. If so, please upload a file of the plan
48. 8. How long do you anticipate your program or project will need Newton County funding?*

    Enter duration of need here.

50. 9. What steps are you taking to become independent and not need Newton County funding?*

    Describe steps here.

52. 10. Please provide in detail what you specifically utilize the funding you receive from Newton County for in your program operations.*

    Please be specific.

54. 11. Please provide an explanation for any change in your request from the prior years.*

    Please be specific.

56. 12. How does your organization or program benefit Newton County and its citizens?*

    Describe benefits here.

58. 13. If you received funds from Newton County in Fiscal Year 2023 please provide specific examples of how those funds were used to benefit our community during the past year.

    Please be specific. 

60. 14. if you received funds from Newton County in Fiscal Year 2023 please provide specific goals set by your organization

62. a. Please provide all goals relevant to funds provided by Newton County.
64. b. Please provide details regarding your organization's performance in achieving those goals.

66. 15. Please review the Newton County Strategic Plan and respond to the following for fiscal year 2024:

68. a. What specific projects or programs will Newton County funds be used to support?*
70. b. What goals do you have hope to accomplish during fiscal year 2024?*
72. c. How do your goals promote the County's Strategic Objectives?*
74. d. How will you measure your success relative to the projects or programs supported by Newton County funds?*
    1. Please provide goal measures in terms of one of the following:
       1. Activities: the processes or actions that use a range of inputs to produce the desired outputs and ultimately outcomes. In essence, activities describe "what we do".
       2. Outputs: the final products, or goods and services produced for delivery. Outputs may be defined as "what we produce or deliver".
       3. Outcomes: the medium-term results for specific beneficiaries that are the consequence of achieving specific outputs. outcomes should relate clearly to your strategic goals and objectives. outcomes are "what we wish to achieve".
       4. Impacts: the results of achieving specific outcomes, such as reducing poverty and creating jobs.
76. Please provide the following along with your application:
78. Proof that you have been a designated and recognized non-profit entity for 12 months prior to seeking an external appropriation.*
80. Documentation from both the state and federal government evidencing the entity's tax status.*
82. Last fiscal year's operating budget detailing costs and credits*
84. Organization creation documents*
86. Identify all board members*
88. Certified minutes from at least three Board meetings in the previous year.
90. *Newton County Board of Commissioners reserves the right to deny a request from any external appropriation for any reason at all.
Leave This Blank:


92. 1. Receive an email copy of this form.
93. Email address

    This field is not part of the form submission.

94. Submit

* indicates a required field