Operation Round Up Online Form

Contact Person

Organization Name (check payable to)

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Cell Phone or Add'l Contact Info

Website

Grant Amount Requested

Total Amount of Project/Event

Number of People Benefitting From Project/Event

Has your Organization Received a Previous Grant form ORU Program?

Yes

If Yes, When, What Project or Event was the Previous Grant For?

Is the organization Non-profit? Only non-profit organizations will be considered for funding. Please include 501 c (#) form. Failure to do so, may disqualify application.

Yes

501 c (#) Form

Upload requirements

Project/Event Date

Name of Project/Event

Funds Used For

How Project/Event Benefits Community

Organization History

Organization Mission & Goals

Other Revenue Sources

I will, or will not allow a photo with my name and organization to appear in FMEC publications.

I will allow

I will not allow

Signature - By entering your name, you authorize to have your name or photo to appear in FMEC publications

By submitting this application, I certify the information provided is true and complete.

(If a school, MUST be signed by the Principal of the school)

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