CI Eligibility Questionnaire

Focus Areas(Required)

Which focus area(s) does your program fit within? Check all that apply.

Health Access

Economic Mobility

Educational Equity

Poverty Reduction

Other

Guidelines

Check all that apply. *The Chattahoochee Valley includes any of the following counties: Chattahoochee, Clay, Harris, Marion, Muscogee, Quitman, Stewart, Taylor, and Talbot Counties in Georgia and Russell County in Alabama.

Yes – this program serves the people of the Chattahoochee Valley*

Yes – we want to apply for general operating or programmatic funds (not for a capital campaign or endowment)

Yes – our organization is a public charity, organized under IRS Sec. 501 (c)(3)

Requirements

Before considering an application, United Way requires funded programs to submit documentation. Please check all the items listed below that your organization can provide documentation for.

IRS Determination Letter of 501 (c) 3 Tax Exempt Status

Annual Independent Audit, including management letter if issued (depending on overall income amounts)

Most recent IRS Form 990 or 990EZ

Recent Financial Statements: Submit your most recent 5 months’ unaudited (board-approved) financial statements.

Regular Board meetings

Registered as a Charitable Organization

Non-discrimination Policy

Hidden

We are NOT seeking funding for

Check all that apply.

An individual

A fundraiser or sponsorship, one-time event, or dinner

A startup organization

Name(Required)

First Last

Organization(Required)

Email(Required)

Phone(Required)

Name

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

Community Investment Eligibility Questionnaire

Community Investment Eligibility Questionnaire

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