Nonprofit Qualification Form
This form is to be completed by a representative of the nominated nonprofit to confirm eligibility for funding consideration. Once eligibility is verified, the charity will be added to our list of qualified charities eligible for presentation and funding consideration at a future meeting.
Organization Name *
Your answer
Nonprofit Status *
Required
Federal Tax ID *
Your answer
Contact First Name *
Your answer
Contact Last Name *
Your answer
Contact Title *
Your answer
Email *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Mission Statement *
Please include a short mission statement that we may post on our website.
Your answer
Annual Operating Budget *
Annual operating budget must be at least $100,000.
Your answer
What percentage of overall funds are allocated to providing services in Yolo County?
You must agree to spend 100% of our donation in Yolo County. If you do not work exclusively within Yolo County, please specify the percentage of your overall budget that is spent in Yolo County and describe where else you work.
Your answer
Date Established *
Organizations must have been in operation for at least three years.
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Website *
Your answer
(Optional) What is the impact of $100 to your organization?
If possible, please let us know what $100 can do for you (# people helped, pounds of food, # classes offered, etc.). This will help us spread the word of how much impact our group can make.
Your answer
Acknowledgment of Terms *
Required
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