Round Up For Change Form

Round Up for Change Application

This form requests the necessary information from non-profits who wish to be considered for Round-Up donations. It also collects art and content for purposes of marketing the organization if they are chosen to participate.

Organization Information

We need some basic information about your organization and who to contact about the Round-Up program.

Organization Name(Required)

The official name of your organization

Organization PHYSICAL Address(Required)

Street Address Address Line 2 City State ZIP Code

Is your organization MAILING address different from the mailing address?(Required)

If you answer yes, please be sure to fill in the mailing address, next.

Yes

Organization MAILING Address

Enter information ONLY if the organization's mailing address is different from the physical address.

Mailing Address (PO Box) City State ZIP Code

Organization Primary Telephone(Required)

Organization Website(Required)

Social Media(Required)

Check all that apply.

Facebook

Instagram

Twitter

We do not use social media

Is this Organization a registered 501(c)3?(Required)

Yes

Must be a registered non-profit to qualify for the Round Up program

Provide Organization's EIN #.(Required)

Fiscal Sponsor (if applicable).

Organization's Contact Person Information

Contact Name(Required)

This is the person we will need to be in contact with regarding all aspects of the Round-Up program.

First Last

Preferred Pronoun

Please tell us your preference.

She, Her, Hers

He, Him, His

They, Them, Theirs

Other

Other

Please let us know your preferred pronoun if we didn't list it.

Contact's Position/Title(Required)

Contact's Telephone(Required)

Extension (if applicable)

Contact Email(Required)

Mobile?(Required)

Does the contact telephone accept texts?

Yes

Round-Up Eligibility Information

Why should your organization be considers for our Round-Up for Change program?(Required)

Please tell us why in just a sentence or two.

Tell us more...(Required)

Please explain how the work and the mission of your organization align with the Co-op's goals and Ends Policies (Click here to review our Ends Policies ). And, how would the monies raised through our "Round-Up" program benefit your work in relation to the Co-op's mission?

What are your plans for these funds?(Required)

Please tell us how you plan to use the donated funds we raise for your organization if we feature your organization in our "Round-Up for Change" program..

Would you be willing to do a tabling session at least one time during the month you are selected?(Required)

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