FOR OFFICE USE ONLY:ALL QUESTIONS MUST BE FILLED OUT COMPLETELY Program Guidelines The mission of the Union Rural Electric Trust is the accumulation and disbursement of funds for charitable purposes in Union County, Ohio and/or areas within the Union Rural Electric Service Territory. This shall be accomplished by disbursement of funds to organizations for charitable, educational, or similar activities or programs that benefit residents of the Union Rural Electric Service Territory. Disbursements to organizations are limited to $3,000. No applicant may receive disbursement more than once every year. *** FOR CURRENT FUNDRAISING ACTIVITIES *** You must include a balance sheet showing the total amount of funding needed IN ADDITION TO: Total amount gathered to date. Funds must be used within 60 days or forfeited. These limits may be increased by two-thirds vote of the entire Board of Trustees. This statement may be modified by a two-thirds vote of the entire Board of Trustees. Applications must be completed and received in the offices of URE no later than 10:00 a.m. on the Friday before the last Thursday of the month (second to last in November) in order to be considered. Adopted March 29, 1999, revised October 2023 by the Union Rural Electric Trust Board.Group/Organization Information(Required) Name of Group/Organization Address City State / Province / Region ZIP / Postal Code Contact Information(Required) Daytime Phone Evening Phone Best Time to Reach Contact Person INFORMATION of Group/Organization's Point of Contact(Required) Name of Point of Contact Title Address City ZIP AMOUNT REQUESTED. NOT TO EXCEED $3,000(Required) PROPOSED USE OF FUNDS: ***Include necessary documentation***(Required)State type of group/organization, ownership, non-or-for-profit, and tax status. If exempt from payment of income taxes, please attach form 501(c)3 letter from Internal Revenue Service.(Required)UPLOAD 501(c)3 from IRSMax. file size: 512 MB.UPLOAD financial statements, including sources of income, for one previous year. Also provide a copy of your group/organization's by-laws.(Required)Max. file size: 512 MB.IS YOUR GROUP/ORGANIZATION RECEIVING OR REQUESTING ANY OTHER FORM OF ASSISTANCE FOR STATED REQUEST? (donation, grant, etc)(Required) YES NO List all other forms of assistance or aid your group/organization is receiving or requesting.(Required) Number of individuals, families, or groups your organization currently serves WITHIN the URE service area(Required) Number and location of individuals, families, or groups your organization serves OUTSIDE of URE service area.(Required) How are your group's programs measured for effectiveness?(Required)If these funds will be used to support any candidate for public office or any political purpose, Explain here:(Required) REFERENCE #1: (may not be a trustee or employee of URE or URE Trust)(Required) Name Address City ZIP Phone Number REFERENCE #2: (may not be a trustee or employee of URE or URE Trust)(Required) Name Address City ZIP Phone REFERENCE #3: (may not be a trustee or employee of URE or URE Trust)(Required) Name Address City ZIP Phone ADDITIONAL COMMENTS:UPLOAD SUPPORTING DOCUMENTATION (INCLUDING ESTIMATES, ETC.)(Required)Max. file size: 512 MB.AUTHORIZED REPRESENTATIVE(Required) I represent that I am authorized by the named organization to make this application on its behalf and to make the assertions in this certification and to bind the organization accordingly. The information contained in this statement is for the purpose of obtaining funding from the Union Rural Electric Trust for the benefit of the undersigned for food, shelter, equipment, clothing, health expenses and education. The undersigned understands that the information provided herein, including but not limited to, conversations with references and background checks, is used in deciding whether to grant funding and the undersigned individually represents and warrants that the information contained herein is true and complete and that the Union Rural Electric Trust may consider this statement as continuing to be accurate. All information, including conversations with references and background checks will be kept in the strictest confidence and will be used only for intended purposes. I understand that the Union Rural Electric Trust has the right to fully audit the use of the donation at any time and may or may not grant funds at its sole discretion.FUNDS WILL NOT BE USED FOR POLITICAL PURPOSES I understand that these funds will not be used to support any candidate for public office or any political purpose. I understand that the Union Rural Electric Trust has the right to fully audit the use of this donation at any time. I also understand that Union Rural Electric Trust may use this application, if approved, for publicity and promotional purposes.Name of Group/Organization(Required) Date(Required) MM slash DD slash YYYY Signature of Representative(Required) Title of Representative(Required) PhoneThis field is for validation purposes and should be left unchanged.
