Operation Round-Up® Organizational Application

Please review the Trust Funding Guidelines (PDF) before completing your application.

Note: Please review your application before submitting. Incomplete forms or insufficient information will cause your application to be returned or denied. Applications must be received by the deadline. Please check the deadlines. Visit Our Operation Round Up® web page. Applications received after this date will be held for the next meeting.

Organization Information

Organization Name(Required)

Contact Person/Title(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

Physical Address(Required)

Same as previous

Phone Number(Required)

Email(Required)

We will be primarily communicating via email about grant requests.

Website(Required)

Federal Tax ID #(Required)

Is the organization a 501(c)(3)?

*If the organization is requesting funding exempt from payment of income tax, a copy of IRS 501(c)(3) letter must be attached.

Max. file size: 100 MB.

Contributions to organizations will generally be made only to nonprofits that have been granted tax-exempt status under Internal Revenue Code Section 501(c)(3).

Financials

Please attach a copy of financial statement for the previous year.(Required)

Accepted file types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg, Max. file size: 20 MB.

For school requests, please attach PTO budget.

One file only.

Accepted file types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg, Max. file size: 20 MB.

Private school annual tuition $:

Mission & Service

Provide a brief explanation of the organization’s mission:

Attach additional pages here:

One file only.

Accepted file types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg, Max. file size: 20 MB.

List the number of individuals, families or groups your organization serves annually in the following counties below. If none, enter 0.

Kootenai:

Benewah:

Bonner:

Spokane:

Total number served:(Required)

Does the agency serve outside the above mentioned counties?(Required)

*Please provide information on number served and location:(Required)

How many people will the funding request affect in the next calendar year:(Required)

Is the organization a United Way Agency?(Required)

Is the organization affiliated with any religious organizations?(Required)

Please provide more information:(Required)

Does the organization receive any state, federal or tribal funds?(Required)

Please provide more information:(Required)

Is your organization anticipating or currently involved in any lawsuits or litigation?(Required)

Please provide more information:(Required)

Request Information

What is your request amount? $(Required)

Please enter a number less than or equal to 2500.

How will the funds be used? Please be specific.(Required)

Attach related documents or supporting information (e.g. invoices, bids, etc.).

One file only.

Accepted file types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods, Max. file size: 20 MB.

Attach images or photos.

One file only.

Accepted file types: gif, jpg, png, svg, Max. file size: 20 MB.

How do you plan to evaluate the success of your project or program?(Required)

Does your organization (or program) have other sources of funding?(Required)

Reference #1

Name(Required)

Phone(Required)

Reference #2

Name(Required)

Phone(Required)

Reference #3

Name(Required)

Phone(Required)

Representative Electronic Signature (Full Name)(Required)

I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.

Please review and initial below:(Required)

If the request above changes or is funded by another source prior to the Trust Board’s quarterly meeting, the organization agrees to return the funds and/or reapply.

Phone

This field is for validation purposes and should be left unchanged.