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The KEC office will be closed on Monday, October 14, 2024, for employee training.

Operation Round Up Organizational Application

Organization Information

Organization Name

Contact Person/Title

Mailing Address

Address 2

City/Town

State

ZIP/Postal Code

Is your physical address the same as your mailing address?

Physical Address

Address 2

City

State

ZIP/Postal Code

Phone Number

We will be primarily communicating via email about grant requests.

Website

Federal Tax ID #

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.

Financials

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

For Schools

For school requests, please attach PTO budget.
One file only.
20 MB limit.
Allowed 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.

Private school annual tuition:

Mission & Service

Provide a brief explanation of the organization’s mission (attach additional pages as needed):

Attach additional pages here:
One file only.
20 MB limit.
Allowed 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.

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:

Does the agency serve outside the above mentioned counties?

*Please provide information on number served and location:

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

Is the organization a United Way Agency?

Is the organization affiliated with any religious organizations?

Please provide more information:

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

Please provide more information:

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

Please provide more information:

Request Information

What is your request amount? $

$2,500 maximum

How will the funds be used? Please be specific.

Attach images or photos.

One file only.
20 MB limit.
Allowed types: gif, jpg, png, svg.

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

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

Reference #1

Name

Phone

Reference #2

Name

Phone

Reference #3

Name

Phone

I agree to the following.

The information contained in this statement is for the purpose of obtaining funding from the Kootenai Electric Trust on behalf of the undersigned. Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and complete and that the Kootenai Electric Trust may consider this statement as continuing to be true and correct until a written notice of a change is provided. The Kootenai Electric Trust is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein. We understand that if we are selected for funding by the Kootenai Electric Trust our name may be used in the promotion of the Operation Round Up Program and we will be asked for a photo or video to aid in promotion.

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 here for deadlines. Applications received after this date will be held for the next meeting.

Please review and initial below:

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.

Signature of representative:

Sign above

Today's Date:

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Operation Round Up Organizational Application

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