Primary contact name and title:*
Charity/Organization name:*
Charity/Organization email:*
Charity/Organization phone:*
Charity/Organization address:*
Charity/Organization website:*
Charity/Organization social media handles (Instagram, Facebook, YouTube, etc.):*
Please add any other contact information you think we should have.
What is the mission or purpose of the Charity/Organization, in a short statement?*
What is the proposed program name? *
Please explain the program in a short paragraph, including who it will serve, what they will do, where it will happen, the start and end dates and if you expect the program to run annually. *
What are the overall program goals?*
How will you measure success? *
How many children do you expect to impact with the program and what portion are underserved (and please help us understand how you define underserved)?*
Who will be the program champion (i.e., the primary advocate and point person for communication), and , if different than above, what is their specific contact information?*
What is the requested funding amount for the program, and what other source(s) of funding are to be received for this program, including amount(s)?*
Please upload a copy of the program budget with specific line-by-line details and amounts.
To whom will the program funds be paid (exact name to be written on the check) and to whom should they be mailed at what address?*
How will Mary's Giving Fund be recognized for supporting this program (e.g., website, media coverage, social media, public relations, logo placement on items distributed, etc.)?*
Please provide photos, videos, samples, or links that we may use on our website or in our promotional materials.
For any provided picture(s) or video(s) of any adult(s) or child(ren), have you or will have you obtained the appropriate or necessary permission(s), release(s), or waiver(s) from the appropriate resonsible person(s) such that Mary's Giving Fund may use it (them) on its website or in its promotional materials?
Yes or no? And if no, please explain.*
Is your Charity/Organization an approved IRS 501(c)3 nonprofit? If yes, please attach a copy of your IRS determination letter, and if no, please explain your charitable status.*
Please upload a copy of the IRS determination letter.
Is the annual budget for the Charity/Organization greater or less than $1,000,000?*
Is your Charity/Organization a registered nonprofit in your state? If yes, what state?*
Are all program activities accessible to all members of the public regardless of race, color, religion, sex, national origin, or disability? If no, please explain.*
Please provide two to three references and their contact information from other current or past community partner charity/organizations or financial supporters. If not applicable, please explain.*
How did you hear about Mary’s Giving Fund? If you know any of our volunteers, please provide their name(s). *
Thank you very much for submitting this information. Please indicate below the person at the Charity/Organization who takes responsibility for its truth, accuracy, and completeness and who confirms that Mary's Giving Fund may rely on the same.
Name (in place of a signature), Title, Date:*
