Charity Submission Form 2018
Use this form as a guide for gathering information about the charity you want to recommend as a possible fund recipient. You will likely use some of this in your five-minute presentation, should their name be selected from the drawing. Return this form TWO WEEKS prior to the next meeting.
Email address *
Organization’s Name *
Your answer
Name of Member Submitting First/Last
Your answer
Address (Headquarters And Where Services Are Provided, If Different) And Website *
Your answer
Mission Statement (Any History, Details, Information On The Organization Is Helpful) *
Your answer
Date Started *
Your answer
Is the organization a 501c3 certified charity?If yes, please provide FEIN. *
Your answer
What Are The Current Sources Of Funding For The Organization? *
Your answer
Do you have major sponsors or donors? If yes, describe. *
Your answer
What population does the organization serve? *
Your answer
How do you identify and qualify a proper beneficiary? *
Your answer
What capacity currently exists to achieve program implementation? *
Your answer
How Would The Donated Funds Be Used? *
If chosen, will you restrict funds to just program efforts only with no funds being used for administrative expenses?If no, how much of the funds are intended to be used for Admin Expenses to implement program? *
Your answer
What Is Your Annual Operating Budget? *
Your answer
What percentage is tied to administrative/overhead vs the program? *
Your answer
Where Are Your Programs Performed? *
Your answer
What past successes have you achieved? *
Your answer
What methods will be used to measure results? *
Your answer
List The 3 Specific, Measurable Outcomes Demonstrating Your Program’s Impact On The Lives Of Those Served? *
Your answer
Describe Your Plan To Sustain The Program Beyond This Grant *
Your answer
Does the organization agree to not use, give, or sell the contact information of our members for additional solicitation by them or other organizations? *
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