UFCU Grant Partner Application

1. About your organization

Please respond to the following questions about your organization and how to reach you.

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* 1. Organization Name

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* 2. Organization Contact Information

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Phone Number *

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* 3. Organization Tax ID Number

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* 4. Person to Contact

Name *

Organization, if different

Email Address *

Phone Number *

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* 5. Executive Leader/CEO/President

Name

Email Address

Phone Number

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* 6. Number of paid, full-time employees

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* 7. Annual operating budget, choose one

Less than $50,000

$50,000 to $100,000

$100,001 to $500,000

$500,001 to $1,000,000

More than $1,000,000

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* 8. Does a different organization serve as your fiscal agent? If so, please enter the name and contact information of your fiscal agent.

Contact person

Fiscal agent

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 9. Organization website

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* 10. Please provide the handle for any/all active social media accounts for your organization.

Facebook

Twitter

TikTok

Instagram

YouTube

Other

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* 11. Please provide a brief summary of your organization: history, mission statement, goals, programs provided, communities served, impact. Just an overview for those who might not be familiar with you. (Max 1,500 characters)

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* 12. Please provide information on the number of people on your BOARD OF DIRECTORS who identify in the following race/ethnicity categories.

Asian

Black of African-American

Hispanic or Latino

Indigenous, Native American, American Indian or Native Alaskan

Middle Eastern, Arab or North African

Native Hawaiian or other Pacific Islander

White, Non-Hispanic

Multi racial

Other Under-represented

None of the Above

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* 13. Please provide information on the number of people on your BOARD OF DIRECTORS who identify in the following gender categories.

Identifies as Male

Identifies as Female

Identifies as Other

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* 14. Please provide information on the number of people on your professional LEADERSHIP TEAM who identify in the following race/ethnicity categories.

Asian

Black of African-American

Hispanic or Latino

Indigenous, Native American, American Indian or Native Alaskan

Middle Eastern, Arab or North African

Native Hawaiian or other Pacific Islander

White, Non-Hispanic

Multi racial

Other Under-represented

None of the Above

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* 15. Please provide information on the number of people on your professional LEADERSHIP TEAM who identify in the following gender categories.

Identifies as Male

Identifies as Female

Identifies as Other