Organizational Application GRANT APPLICATION FOR AN ORGANIZATION AGENCY INFORMATION Name of Organization Address Street or P.O. Box * Street or P.O. Box City * City State * State Zip Code * Zip Code Phone Number Work Work Home Home Other (specify Other (specify Contact Person: Name Name Title Title Email address * Email address Is organization requesting funding exempt from payment of income tax: * Yes No If yes, a copy of letter (Form 501[c]3) from Internal Revenue Service MUST be uploaded.A copy of financial statement(s) for most previous year MUST be provided. Upload 501(c)3 Form * Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Upload Charitable Solicitation License * Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Upload Financial Statements for the previous year * Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Does agency serve outside counties listed above? Yes No If Yes, please provide information on number served and location. We strive to make sure the people we are supporting live within our electric service area. We go by address zip codes to determine if someone lives within our electric service area. Drop a file here or click to upload Choose File Maximum upload size: 134.22MB 2024 Service Area Zip Code Request fillable REQUEST State purpose of Organization/Agency Request: (Please list specifics of how funds will be used.) Copies of bids/ estimates, invoices, project description/plans, etc., supporting your request MUST be attached. * Upload Copy of bids, estimates or invoices for the grant * Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Amount of Request * Upload a photo from the project/program, or a relevant photo if one from the project is not available. * Drop a file here or click to upload Choose File Maximum upload size: 134.22MB List other sources of funding for use of request as described in the above: How are agency’s programs measured for effectiveness? REFERENCES Please list three references (References may not be given by a director or employee of Coweta-Fayette Electric Membership Corporation or Coweta-Fayette Trust.) Name 1 Phone Address Email Name 2 Phone Address Email Name 3 Phone Address Email The information contained in this statement is for the purpose of obtaining funding from the Coweta-Fayette Trust on behalf of the undersigned. Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and complete and that the Coweta-Fayette Trust may consider this statement as continuing to be true and correct until a written notice of a change is provided. The Coweta-Fayette Trust is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein. Name of Organization Name of Organization Signature of Representative Signature of Representative Date Date IMPORTANT APPLICATION INFORMATION: Operation Round Up Trust board meets in January, March, May, July, September and November. Applications must be received at Coweta-Fayette EMC by the 20th day of the month before the meeting. Example: June 20 is the deadline for the July meeting, etc. Please follow instructions on the application carefully and include ALL information requested. NOTIFICATION: You will be notified by mail of the Board’s decision on the request Upload Any Additional Files Here Drop a file here or click to upload Choose File Maximum upload size: 134.22MB If you are human, leave this field blank. Submit Account Services Manage and pay your account online Pay My BillReport An Outage
