Fulton County Community Foundation

Fulton County REMC Operation Round Up® Trust Pass-Through Fund

Download a Fulton County REMC Operation Round Up® application.

Application in pdf format
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You may download it free, with the link below:

The fund was established in March 2004 by the Fulton County REMC. The purpose of the fund is to support the charitable intentions of the Operation Roundup® Trust.

Operation Round Up® is a voluntary fundraising program where Fulton County REMC members donate the spare change on their energy bill to help those in need throughout the community. With an average donation of only $6.00 per year, and never more than 99 cents a month, members make a small investment that pays big dividends in the community. Operation Round Up® is families working together to improve their collective quality of life.

The program is simple. When a member of the Fulton County REMC agrees to participate, they round up their energy bill to the next dollar. The difference goes into the Operation Round Up® Trust.

Operation Round Up® can help the community fund needs such as:

Operation Round Up® does NOT:

Applications are available at the Fulton County REMC office, the NICF office and are available to download and print out as both Adobe PDF file and HTML Printable here from this page
.

If you know of an organization seeking funding for a community project or program that fits within the above areas of consideration, encourage them to apply for a grant from the Fulton County REMC Operation Round Up® Fund.

FULTON COUNTY REMC OPERATION ROUNDUP ® TRUST
1448 W State Rd 14
PO Box 230
Rochester, Indiana 46975-0230
(574) 223-3156 – (574) 223-4353 Fax
www.fultoncountyremc.coop

APPLICATION FOR DONATION
ORGANIZATION/AGENCY

Name of Organization/Agency ____________________________________________

Street Address ____________________________________PO Box_______________

City or Town ____________________________State________Zip Code __________

Phone Number ______________________________

Contact Person ______________________________

Is the organization requesting funding exempt from payment of income tax?
Yes ____ No ____
If yes, a copy of Form 501[c]3 from the Internal Revenue Service must be attached.
A copy of your financial income and balance statements for the most previous year should be provided.
Please know we are interested in the general publicly disclosed statements, not your detailed information.

A copy of the most recent income statement is attached. Yes ____
A copy of the most recent balance statement is attached. Yes ____

NATURE OF REQUEST

Briefly describe the project for which you are requesting a grant:

Amount you are requesting: $______________

Amount needed for project: $______________

Deadline when grant needed: _____________________________________

What is the expected completion date: _____________________________
FULTON COUNTY REMC OPERATION ROUNDUP® TRUST

Is your organization contributing to the project in terms of cash and/or in-kind/non-cash? If so, please provide details of the contribution:

From what other companies/sources of revenue are you requesting a contribution and for how much?

Who will benefit from this project?

Number of individuals, families or groups served by your organization/agency in the past year:

If we support your project, how will you measure its effectiveness and follow-up with us with your results?

Are there specific results/outcomes that are expected?

MORE ABOUT YOUR ORGANIZATION

Do you have a Board of Directors? Yes____ No ____

What are your annual operating expenses? Year ________ $___________

What are your annual fund raising expenses? Year ______
(As a dollar and/or percent of total operating expense) $_________

Briefly describe your organizations financial accountability. Are you audited independently on an annual basis?

Please list ways we might be recognized for awarding a grant to your organization:

FULTON COUNTY REMC OPERATION ROUNDUP®TRUST

CONTINGENCY PLAN

If we are unable to award a grant for some or your entire requested amount, what is your back-up plan?

The information contained in this statement is for the purpose of obtaining funding from the Fulton County REMC Operation Round Up® Trust on behalf of the undersigned. Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and complete and that Fulton County REMC Operation Round Up® Trust may consider this statement as continuing to be true and correct until a written notice of a change is provided. The Fulton County REMC Operation Round Up® Trust is authorized to make all inquires they deem necessary to verify the accuracy of the statements made herein.

I understand in applying for funding that if granted, it will be used for the sole purpose as stated in this application. I will also submit a letter within one year that the funding has been used for the purpose requested.

Further, I understand that if funding is received, I grant permission for its publication in the Fulton County REMC’s monthly publication as well as any other publication the Fulton County REMC deems appropriate.

Name of Organization

Signature of Representative

Signature of Representative

Date
For Trust Use Only

Approved_____________________ Date________________Amount______________
Declined _____________________ Date ________________
Operation Round Up®: Organization-Agency Application 1/19/2004