ESC Charitable Request

ESC Charitable Request

Standard online request form for the ESC Charitable Request process. Complete all fields and certification areas for submission.
Applicant and Organization Information
Today's date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date funds needed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Amount requested
Requesting organization (legal name)
DBA, if applicable
Organization mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Contact person

First NameLast Name
Title
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Website
Check payable to (no individuals)
EIN
FL registration no.
Project Description and Benefit Details
Describe your organization and the project this request supports
Describe exactly how ESC funds will be used. Itemize
Total individuals who will directly benefit from these funds
Of that total, number with a military affiliation
Percentage with military affiliation
How was this count produced? Name the records used and the period they cover
Team Eglin Connection and Member Engagement
Describe the connection to Team Eglin
Volunteer opportunities available to ESC members: roles, hours, frequency
Site visit or tour availability, and services ESC members may access directly
How ESC will be recognized
Eligibility and Funding History
501(c)(3) organization?
MWR or Services facility?
Eligible for appropriated or non-appropriated funds?
If yes, which?
Previous ESC funding?
Year and amount
Close-out report filed?
Have you requested or received funding for this project from any other source in the last 12 months? List every source, the amount, and the date received.
Total raised for this project from all sources, last 12 months
Amount still needed after all other funding
Authorization and Internal Review
School Principal's Signature
School Principal's Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Certification Signature
Certification Printed Name and Title

First NameMiddle NameLast Name
Should be Empty:

ESC Charitable Request

Applicant and Organization Information

Project Description and Benefit Details

Team Eglin Connection and Member Engagement

Eligibility and Funding History

Authorization and Internal Review