Non-Profit Eligibility Form
~ for the non-profit to complete and submit ~

This form is to be completed in full by the leadership of a Lincoln County non-profit to confirm eligibility for funding consideration.  We want to simplify this process and your work. This form only needs to be filled out one time per non-profit and will remain on file.  

Once eligibility is verified, we'll gleefully add the organization to our list of non-profits eligible for nomination and consideration for an Impact Donation.  

Please note that once your organization is declared eligible, it will need to be nominated  by a member ahead of a meeting to be considered for funding.

Thank you for bringing our collective attention to the powerful work you accomplish every day on behalf of our community. 

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Name of Organization *
Name and Title of person completing this form *
Email of person completing this form *
Organization's Website *
Organization's Address *
EIN# *
Name and title of Executive Director or equivalent *
Email of ED or equivalent *
Phone # of ED or equivalent *
Has your organization been a 501c3 for at least two years? *
Organization's Mission *
If awarded, how do you see this organization using the funds? *
If your organization's service area reaches beyond Lincoln County, would you be able to guarantee funds will be used to serve ONLY Lincoln County? *
If no, please explain: *
Has your organization been awarded an impact donation by another "100+" affiliate within the past 3 years? *
My organization agrees to:
>Keep 100% of the Impact Donation local to Lincoln County
> If awarded an impact donation, send a representative to our next meeting to share how the money was, or will be spent
> Never create, sell or distribute a list with our member's contact information
> Not solicit our members directly for further contributions  (unless they were prior contacts of yours) *
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