Annual Operating Budget Support Request

Nonprofit Funding Request
Deadline: This application is due at 5:00 pm on January 31, 2026

The Town of Kernersville considers funding nonprofits based on the services they provide to the citizens of Kernersville. Funds may also be provided to nonprofits based on the amount of travel and tourism they bring to Town.
To Save Your Application
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Does your program operate in Kernersville?*

YesNo
Only nonprofits located in Kernersville are eligible for funding from the Town of Kernersville

1. Online Application
Organization Name*
Is the name above the same as it appears on the IRS Letter of Determination?*

YesNo
If not, please explain.
Tax Status?*

501(C)(3)Other
Tax ID (EIN)*
If not 501(c)(3), what is your tax status?
Does your organization have a Charitable Solicitation License from the State of North Carolina.*

YesNo
Charitable Solicitation License Expiration Date?
Year Organization Incorporated*
Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
Upload IRS determination letter

Upload a File

Cancelof
Upload most recent 990

Upload a File

Cancelof
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form via the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

2. Contact Information
Contact*

First NameLast Name
Contact Title*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How long have you been in this position?*
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Chief Executive Information (Only complete if different from contact)
Chief Executive Full Name

First NameLast Name
Title
Phone Number

Area CodePhone Number
E-mail
example@example.com
Does Your Organization have a Board of Directors?

YesNo
How many directors serve on your Board currently?
Please upload a list of your current Board of Directors

Browse Files

Cancelof
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form via the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

3. Financial Information
Operating Budget $ (Organization)*
Fiscal Year Starting *
Fiscal Year Ending *
Sources of Income:
Government %*
Individual Contributions %*
Foundation Grants %*
Fees / Earned Income %*
Corporate Grants %*
Other %*
Past recipient of Town of Kernersville funding?*

YesNo
Amount of Town funding requested in FY 2025-2026
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form via the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

Organization Numbers
Number of clients or citizens served in 2025
Number of clients or citizens served in 2025
Number of volunteers in 2025
Total number of volunteer hours in 2025
Number of volunteers in 2025
Total number of volunteer hours in 2025
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form via the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

4. Funding Information
How will Town funds be used?*

Specific ProjectOperating Support
Amount of this request?*
How will Town funds be used (please use this space to explain)*

0/200
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form from the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

5. Narrative

This section must be completed with either a file upload or fill in the box below
Please limit the length of your answer for the following questions to the character limit indicated.

We want to learn:
- Your mission
- The strategies used to achieve the mission that are measurably effective
- The organization has the capacity to be successful and sustainable
- What programs are you offering (any new programs)
- Are you getting feedback from your customer/clients? If so, how are you using that feedback?
- What is your positive impact on our community?
Include organizational mission statement and purpose, organizational qualifications, history of accomplishments, and governance. (If you work with other organizations, describe your work with other agencies) You may upload a word document below if you choose instead of using the space provided below.

0/300
You may upload a word document here that includes your mission statement and purpose, organizaitonal qualifications, history of accomplishments, and governances.

Browse Files

Cancelof
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form via the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

5. Narrative
Please list any other financial or in-kind allowances received from the Town
If there is any other information that you believe the Town needs to know, please upload that information here.

Browse Files

Cancelof
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form via the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

6. Grant Submission
*

I agree that the insertion of data into the following fields constitutes an electronic signature.
I understand that if I receive funding from the Town of Kernersville I will be required to submit funding reports as required by the Town.
*

I understand that by submitting this application I certify that all statements and representations are true and correct. I understand that I may be held civilly and/or criminally liable under federal or state law for knowingly making false or fraudulent statements. I grant the Town of Kernersville or its agent, authority to verify records, public, and private, for the purpose of evaluating this request for financial assistance, and to physically inspect any funded project. Information provided to and obtained by the Town of Kernersville may be subject to public disclosure during deliberations of the Town of Kernersville at public meetings, in minutes of public meetings or under the North Carolina Public Records Act.
*

I certify that I am authorized by the the Executive Director and / or Board of Directors to submit this proposal on behalf of the organization.
Name
Title
Date
Should be Empty:

Nonprofit Funding Request

1. Online Application

2. Contact Information

3. Financial Information

Organization Numbers

4. Funding Information

5. Narrative

5. Narrative

6. Grant Submission