City of Durham – Seven Stars Giving Campaign Application If you have any questions regarding the application, please email email@example.com 7 Stars Online Application Federation/Agency Name(Required) Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person's Name(Required) First Last Contact Person's Title(Required) Contact Person's Email(Required) Organization Phone #(Required)Are you Applying as a Federation or Independent Agency?(Required) Federation Independent Agency How Many Agencies are you applying on behlaf of?Federation CertificationFor FEDERATIONS: In completing this application, a federation should provide all information and documentation requested as it applies to itself. It is not necessary to provide documentation on each individual member agency. However, by making application a federation certifies that: 1. It has on file the appropriate information and documentation on each of its member agencies; 2. Individual member agencies meet all of the criteria for this campaign. In instances where an individual member agency does not meet a specific criterion, the federation must make full disclosure of this fact on an attachment and provide appropriate explanation. I certify the statement below is trueIndependent Agency CertificationIn completing this application, an independent agency should provide all information and documentation requested. In instances where an independent agency does not meet a specific criterion, the agency must make full disclosure of this fact on an attachment and provide appropriate explanation. I agree to the below statementsUpload a copy of you organization's 501(c)(3) IRS tax-exempt letter(Required)Max. file size: 50 MB.Upload your Current Board of Directors List with mailing address for each Board member(Required)Max. file size: 50 MB.Upload Most Recent Audit Performed by an independent CPA(Required)Max. file size: 50 MB.Upload your organization's most recent IRS Form 990(Required)Max. file size: 50 MB.Agency 25 Word Statement(Required)Description to be used on the campaign website Federation Member DescriptionsPlease upload the spreadsheet provided with the application materials (file name - "Federation 25 Word Statements") that includes all your member agencies and their 25 word descriptionsMax. file size: 50 MB.What percent is your organization's FRA expense based on the 990 you submitted?(Required)FRA is your combined fudnraising and administrative expenses, which can be calculated from your IRS Form 990High FRA% ExplanationPlease provide a brief explanation for why your FRA% exceeded 25% and what organizational steps you are currently taking to lower it.Max. file size: 50 MB.Upload A Current North Carolina Solicitation LicenseMax. file size: 50 MB.Exempt agencies, please provide reason for solicitation license exemptionIf your organization is not required to have a solicitation license provide the reason in the space belowApplication Certifications(Required)Choose click all boxes that apply for your organization Agency has a 501(c)(3) exemption from the US Internal Revenue Service and is also tax-exempted by the State of North Carolina Board of Directors meets regularly and directs the agency Elected members of the Board of Directors do not receive compensation for service All publicity and promotional activities are truthful and non-deceptive Contributor lists are maintained in confidence and are not shared with others, unless specifically requested by the donor No commissions, kickbacks, finder’s fees, percentages or bonuses are paid to individuals for fundraising Agency has policies that prohibit discrimination against individuals seeking services on the basis of race, color, religion, sex, age, sexual orientation, national origin, and physical or mental disability Federations: Administrative fees (if any) for all contributions received through the 7 Stars Employee Giving Campaign will be kept at or below 10%. What type of services does your agency provide to the citizens of the city of Durham?(Required) My agency provides services that offer a direct benefit to Durham citizens. These services are obtainable by Durham residents within reasonable commuting distances. My agency provides indirect services, benefits to the citizens of the City of Durham My Agency is organized to provide services overseas Upload a description of the demonstrated impact of indirect services on Durham citizensPlease provide documentation of any and all individual services that offer indirect benefits to Durham citizensMax. file size: 50 MB.Do all of your member agencies you are applying on behalf of meet the criterion this application lays out? Yes No Upload Disclosure and Explanation of members not meeting application criteriaUpload a document that discloses each member not meeting criteria as well as itemizing the criteria they do not meet as well as an expalnation as to why they fail to meet themMax. file size: 50 MB.Board Approval and Signatures(Required)Please complete page 3 of the application instructions document, including appropriate signatures and uploadMax. file size: 50 MB.Upload a Video to be featured on the 7 Stars campaign website [OPTIONAL]Upload a video representative of your organization and its work that will be included on the campaign website for employees. Video should be under 3 minutes and upload is limited to files under 250MBMax. file size: 250 MB.2022 Acknowledgment PolicyFederations and Independent agencies are responsible for sending thank you letters to all donors. Federations may send letters on behalf of their agencies or choose to have the letters come directly from the recipient agencies. Failure to send thank you notes may affect participation in future campaigns.