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Application for Funding

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Board of Directors: Please provide Name, Email, Telephone for each member.

Does your agency comply with the requirement that recipients of services not be discriminated against for any reason, including, but not limited to race, family status, color, religion, national origin, handicap or age?
Has there been a change in your tax exempt status?
Are you a ministry of a religious organization? If, so please list name, address, and phone of contact organization.
If Applicable
What are your hours of operation?
If available, please list a number besides the office where the director can be reached after hours.
How many volunteers do you have?
How often do you have volunteer and board training?
What services do you provide?
Do you acknowledge that your agency offers free services to women and families to help them choose life for their unborn children.
*
Do you acknowledge that your agency is not associated with abortion activities, including counseling for or referrals to abortion clinics, providing medical abortion-related procedures, or pro-abortion advertising?
Use space below to include any additional information you would like to share about your agency.
Federal Form 990 (most recent). If extension has been filed please send copy of extension then submit copy of 990 when completed.
Copy of most recent confirmation of registration certificate from Secretary of State’s office
If religious organization copy of letter of exemption from registration from Secretary of State
If you fall under the umbrella of a local church and are not required to register with the Secretary of State’s office, please send letter from church stating you are part of their ministry and not required to register if you do not have a letter of exemption.
Copy of New Year budget
Financial Statement (Audited copy if receipts over $500,000.00)
Copy of tax exempt letter from IRS
Copy of criteria for funding checklist

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