First Sunday Giveback Nomination Form

FIRST SUNDAY GIVEBACK CONGREGANT NOMINATION FORM (ORGANIZATION INFO FORM)
Dear First Unitarian Church of Dallas Congregant,

Thank you for your interest in nominating an organization to be recipient for our church’s First Sunday Giveback.

Please carefully review the Congregant Nomination Guidelines, which detail the requirements for both the Nominator (you) and the organization.
Applicable deadline date

MonthDayYear
Date
All information provided below is accurate and truthful.

I have read and understand the Congregant Nomination Guidelines and agree to its terms.
Nominator’s signature

Clear
Date

MonthDayYear
Date
Nominator Name
Cell Phone
Email address
example@example.com
Address

Address

Street Address Line 2

CityState

Zip
Nominated Organization Information
Organization Name
Address
City
State
Zip
Phone
Website
Contact person : Name
Contact person : Title
Contact person: Phone
Contact person : Email Address
example@example.com
Fiscal Year: Start month
End month
Geographic area covered
Population served
Check should be made payable to
If this organization is selected, we assume the check should be mailed to the Contact person and Address above. If that is different, please provide alternate information:
Payment Contact name
Title
Street
City
State
Zip
Are there any timing issues that the First Sunday Collection Committee should consider? (In other words, does this organization need this money at a specific time of the year?)
If this organization is not selected for this cycle, would you like it to be considered for the one that follows?

YesNo
Mission/Purpose
What is this organization’s mission or purpose?
How is it this mission/purpose consistent with our UU Principles?
Provide examples of what the organization does to achieve their mission/purpose
Impact: Describe the specific impact that our funding would have on either this organization’s general operations or a special project. If it will impact a special project, please provide details.
Support for and participation with this organization: If you are aware of other First Unitarian congregants who are supporters of this organization, with their permission, please provide their names:
Describe your and other church members’ involvement with this organization (e.g., volunteer, Board member, employee, financial supporter, etc.) Please provide details.
In what specific ways could other First Unitarian congregants become involved with this organization?
FIRST SUNDAY GIVEBACK CERTIFICATION OF CHIEF EXECUTIVE
Organization Name
Deadline date which relates to this application

MonthDayYear
Date
I hereby certify that all information provided in this application is true and accurate.
IRS 501(c3) designation letter dated

MonthDayYear
Date
IRS Form 990 for year
Enter year here
IRS Form 990 for year
Enter year here
Balance Sheet for fiscal year
Enter year here
Balance Sheet for most recent month
Enter month here
Income/Operating Statement for fiscal year
Enter year here
Income/Operating Statement for previous 12 months
Enter Start Month Here
Income/Operating Statement for previous 12 months
Enter End Month Here
Income/Operating Statement for calendar year to date for year
Enter year here
Other
Other
Other
Other
Other
Other
Other
Upload PDF files here.

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Signature

Clear
Name (please print)
Date

MonthDayYear
Date
Date

Executive DirectorChief Executive OfficerOther
Should be Empty:

FIRST SUNDAY GIVEBACK CONGREGANT NOMINATION FORM (ORGANIZATION INFO FORM)

Nominated Organization Information

Mission/Purpose

FIRST SUNDAY GIVEBACK CERTIFICATION OF CHIEF EXECUTIVE