Operation Round Up Application

Operation Round Up Application

Complete this form to apply for Operation Round Up grant funding.
Name of Organization*
Date Organization Established*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Organization Website URL
Contact Person Name*

First NameLast Name
Contact Person Title/Position*
Phone Number*
Please enter a valid phone number.
Email*
Names and Positions of Organization's Directors/Officers*
General Objectives of Organization*
Brief Description of Project or Program for Which Funding is Being Requested*
Grant Amount Requested*
Date By Which Funds Are Needed*

MonthDayYear
Date
Other Funding Applied For To Complete Project*
Please list sources and amounts
Confirmed Pledges and Commitments To-Date (including state and federal funds)
Please list sources and amounts.

About the Progam*

	Yes	No
Is this a new program within an established organization?
Is this grant to supplement an established program?
Does your organization have tax-exempt status under the section 501(c)3 of the IRS code?
Has the organization received funding from Operation Round Up in the past?

If Boone Power's Operation Round Up program is unable to fund your request, what alternatives do you have?*
How do you plan to evaluate the success of this project or program?*
Other pertinent information which you feel would aid in the evaluation of your grant request:
One-Page Detailed Budget for Grant Amount Requested*

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Most Recent Audited Income Statement*

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Most Recent Audited Balance Sheet*

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Copy of IRS Letter Confirming 501(c)3 status, if applicable*

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Should be Empty: