Round Up Application

  • Please enter a value between 0 and 10000.
  • Is organization/agency requesting funding a tax exempt I.R.C. Section 501(c) (3) organization or a governmental entity: If yes, a copy of the organization’s I.R.C. Section 501(c)(3) determination letter from the Internal Revenue Service or evidence of the organization’s status or a governmental entity must be attached.
  • A copy of financial statement(s) for most recent year shall be provided. Please submit your most recent Form 990 or Audit Report. We request the provided information include a detailed balance sheet and income statement for the most recent completed fiscal year.
  • If additional funding beyond the requested amount is required to complete the project/program, please explain how you plan to meet the funding short coming. Explain what you have done to obtain other sources of funding (or what you will be doing to achieve this):
  • The information contained in this statement is for the purpose of obtaining funding from The Energy Cooperative Round Up Foundation, Inc. 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 The Energy Cooperative Round Up Foundation, Inc. may consider this statement as continuing to be true and correct until a written notice of a change is provided. The Energy Cooperative Round Up Foundation, Inc. is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein. Please note that for the organization or agency who receives funding: 1) The Energy Cooperative Round Up Foundation, Inc. publishes the name, amount and purpose of funding granted. You may also be asked for a photograph for public relations purposes. 2) We also ask that you provide the Foundation with information to substantiate the use of funds awarded, such as copies of invoices, pictures of equipment purchased, or a statement describing specifically how the funds were used.
  • * In extreme circumstances and by a vote of the entire Board, this amount can be increased.