Foundation Application Form

Chairperson:

Address:

Phone:

When did the committee form?

If yes, please attached a copy of your incorporation letter or form.

Max. file size: 24 MB.

If yes, please write the number here:

Statement of committee purpose:

Who will be served by this committee?

Parent Agency Name

Parent Agency Address

Parent Agency Phone/Contact

Why is the committee requesting to become a part of the GDCCF?

What will happen to the committee if the GDCCF request is denied?

Please attach a copy of the committee's current year or proposed operating budget: (or explain if unable to do so)

Max. file size: 24 MB.

Explain

How is it determined where the committee funds are spent?

Who is accountable for the collection and disbursement of funds?

Explain

All disbursement from your fund will be made upon presentation of a disbursement voucher signed by two of your committee members and one member of the GDCCF Board of Trustees. List the committee members that are authorized to sign (we will expect you to keep this list up to date):

Please explain in detail on how you intend to meet the IRS requirement to be charitable, literary, scientific or educational?

The committee member contact person will be?

Submitted By:

This will served as your digital signature

200 E. Main Street
Manchester, IA 52057

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563.927.4141

563.927.4141