Please read this form carefully and fill it out completely. Nominations without proper documentation cannot be considered.
Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Relationship to Church
Name of nominated organization
*
Organization's website address
Organization address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Check should be made payable to.
*
What memo line notation should be used with the checks?
Purpose of organiation (quote from mission statement if possible)
*
Do you have a relationship with this organization? If so, what is it?
*
How does the purpose relate to UU principles and values?
*
Geographic area served (e.g., local, regional, state)
*
What is the organization's annual operating budget?
What are the organization’s sources of income?
What percent of operating budget is spent directly on program or direct service?
Is this a 501(c)3 organization? If not, indicate its non-profit status.
Are there ongoing ways First Church members and friends could be involved as volunteers with this organization? If so, please specify.
Whom should we contact if the organization is chosen as a recipient? (Provide name, phone number, email)
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