Unaffiliated Agency Application
2026 Alabama State Employees Combined Charitable Campaign
Preliminary Eligibility Criteria
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Organization Information
Organization Name
*
Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
President/Director/CEO Name
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First Name
Last Name
President/Director/CEO Email
*
example@example.com
Contact Person
*
First Name
Last Name
Contact Person Title
*
Contact Person Email
*
example@example.com
Contact Person Phone
*
Please enter a valid phone number.
Mailing Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I am applying as:
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Please Select
A Statewide Agency: Services are available and provided to citizens across Alabama
A Local Agency: Services are available to citizens in the local campaign community
I am applying for participation in:
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Please Select
LARC 01
LARC 02
LARC 03
LARC 04
LARC 05
LARC 06
LARC 08
LARC 10
LARC 11
LARC 12
Statewide
View county listings for each LARC at https://www.statecombinedcampaign.org/larc-managers/
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Organization Description
If approved, the following information will be published in campaign brochures and online listings.
25-word description of organization
*
To be included in campaign publications
Main Phone Number
*
Please enter a valid phone number.
Website
*
Total management and general expenses (from IRS Form 990 included in this application)
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Found on IRS Form 990 Part IX in "Management and General" total line
Total fundraising expenses (from IRS Form 990 included in this application)
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Found on IRS Form 990 Part IX in "Fundraising Expenses" total line
Total revenue (from IRS Form 990 included in this application)
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Found in IRS Form 990 Part VIII Statement of Revenue in "Total Revenue" line
Organization's AFR Percentage (cannot exceed 30%)
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Calculated automatically from entries above. Equals the sum of "Management and General" expenses and "Fundraising expenses" divided by "Total Revenue"
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Local/Statewide Presence
Include a list of programs or services offered, as well as the address and the phone number(s) of your organization's offices in the campaign area or statewide. In addition, please show the hours your offices are open IN-PERSON and number of paid staff and/or volunteers who actually provide services from each office. In applying for statewide participation, please provide evidence that services of direct benefit to individuals are available to state employees statewide. Representative samples of people directly benefiting from your service would be solid evidence. Organizations who serve the needy overseas are exempt from local/statewide presence only.
List of programs or services offered
*
Please list the address, operating hours, and number of staff/volunteers for the organization's office location(s)
*
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Organization Board Members
Organizations must be directed by an active local board, which meets at least quarterly, whose members serve without compensation (for organizations where a paid executive director or other staff member is a member, volunteers must constitute the majority of the board), and whose members are residents of the local geographic region served. (Organizations serving the needy overseas are exempt from the local geographic region served.) Board members must be Alabama residents. For organizations applying for statewide participation, you must demonstrate a substantial statewide presence with board members residing in at least 6 of the regions: Northwest Alabama, North Central Alabama, Jackson or Madison Counties, West Alabama, Central Alabama, Etowah or Cherokee Counties, East Central Alabama, Southwest Alabama, Wiregrass Area.
Active Local Board Members
*
Board Meeting Dates (minimum of four per year required)
*
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Alabama Fundraising
Provide data demonstrating that at least 60% of the funds your organization raised locally (or statewide) in each of the two fiscal years prior to this application came from individual contributions from within Alabama (organizations serving the needy overseas are exempt).
Alabama Fundraising Breakdown
Rows
2025 Category Total
2025 Alabama Sources
2024 Category Total
2024 Alabama Sources
United Way Funds
State Grants/Contracts
Federal Grants/Reimbursements
Contributions
Investment Income
State Combined Campaign Income
Other Income
2025 Total Revenue (from table entries above)
2025 Alabama Sources Total Revenue (from table entries above)
2025 Revenue Percentage (from table entries above)
Must be greater than or equal to 60%
2024 Total Revenue (from table entries above)
2024 Alabama Sources Total Revenue (from table entries above)
2024 Revenue Percentage (from table entries above)
Must be greater than or equal to 60%
OR
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Supporting Documentation
IRS Form 990
*
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Most recent IRS Form 990 (IRS Form 990 EZ is not an acceptable substitute; however, a pro forma 990 can be submitted).
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Independent Audit
*
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Must be dated within 18 months of this application. For organizations with revenues less than $250,000, an internal review should be submitted.
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Annual Budget
*
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For fiscal year or calendar year 2026.
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IRS Determination Letter
*
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Provide proof that your organization has been granted tax-exempt status under the Internal Revenue Service Code, Section 501(c)(3).
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State of Alabama Incorporation Letter
*
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Provide official documentation that your organization is legally incorporated or authorized to do business in the state of Alabama as a private, nonprofit organization.
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Nondiscrimination Policy
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Provide a copy of the written policy regarding nondiscrimination adopted by your Board of Directors. Please note that a signed statement from a Board Official or Director of the program is not sufficient and cannot be accepted in lieu of your written policy.
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Annual Report or Quarterly Newsletters
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Newsletters must educate the public on the organization’s activities. Newsletters must be at least quarterly.
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OPTIONAL: Impact Story
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Include an impact story from that highlights real experiences from individuals or families that have benefitted from programs or services offered by your organization. Submissions will be featured in campaign communications.
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Certification
I am the duly appointed representative to the organization listed in this application. I certify the information contained in this application is complete and accurate to the best of my knowledge. I understand if my organization is denied during the application process, I can submit clarifying information not missing documentation in the appeal process.
Certifying Representative Name
*
First Name
Last Name
Certifying Representative Title
*
Certifying Representative Signature
*
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