Welcome to the Mecklenburg County Employee Giving Campaign Mecklenburg County Charity 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 Does your organization maintain a physical office in Mecklenburg County?(Required)A physical office cannot be a PO Box and must have at least one staff person that works out of that location. Yes No Physical Address of your Organization(Required)PO Boxes are not allowed for this entry. Must be the address of a physical office with at least 1 staff person working from the office. 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 Email(Required) Organization EIN(Required)Organization Website(Required) Are you Applying as a Federation or Independent Agency?(Required) Federation Independent Agency How Many Agencies are you applying on behalf 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 above 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 above statementsUpload your Current Board of Directors List with mailing address for each 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)This is the description to be used on the campaign website to inform potential donors about your mission.Upload your organization's most recent Annual ReportMax. file size: 50 MB.Federation Member Descriptions and DetailsPlease upload the spreadsheet provided with the application materials (file name – Federation Member Template). Max. 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 Mecklenburg Employee Giving Campaign will be kept at or below 10%. Upload a description of the demonstrated impact of services on Mecklenburg County residentsPlease provide documentation of any and all individual services that offer benefits to Mecklenburg County residents. This can include a list of programs with a brief description of how they impact residents of Mecklenburg County. ***FOR FEDERATIONS – You can upload a single document with a list of all Member services or individual documents for each*** Drop files here or Select files Max. file size: 50 MB. Do all of the member agencies you are applying on behalf of meet the criteria 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 and itemizing the criteria they do not meet as well as an explanation as to why they fail to meet them.Max. file size: 50 MB.Board Approval and Signatures(Required)Please complete the signature approval page and upload hereMax. file size: 50 MB.Signup for ACH Donation DisbursementsWe are making an effort to streamline and expedite payments to organizations. It is not required, but providing your ACH payment information using the link below will ensure we get payments to you more quickly. If you previously sent this info, you do not need to submit again. https://earthsharenc.org/wp-content/uploads/2023/08/ach-request-form-all-campaigns.docxMax. file size: 50 MB.