UFCC Application Form

2017 UFCC AGENCY PARTICIPATION APPLICATION

Please complete this application and provide the required documentation in accordance with instructions contained in the 2017 UFCC Governing Procedures. All organizations must apply every year to be eligible to receive donations from the UFCC. All required documentation must be submitted as requested. Failure to submit documentation will result in denial. Failure to meet all specified criteria will result in denial. Applications should be submitted online by February 1, 2017, 11:59PM.
  • AGENCY INFORMATION

    Please provide correct contact information and general agency information.
  • Please include http:// in your url.
  • In addition to Alachua County, which surrounding Florida Counties, if any, are served by your organization?
  • CRITERIA AND ELIGIBILITY REQUIREMENTS

    To be eligible for inclusion in the 2017 University of Florida Campaign for Charities, the following up-to-date documentation shall be required (out-of-date or expired documents will not be accepted):
  • The organization is registered with the State of Florida Division of Corporations, pursuant to Chapter 617, Florida Statutes.
  • Current year filing of Annual Report
  • The organization is registered with the United States Department of the Treasury and recognized as a 501(c)(3) entity or the equivalent by the United States Internal Revenue Service.
  • The organization is registered with the Florida Department of Revenue, Registration and Subjectivity Section, and received a state tax exempt number pursuant to Section 212.08. Florida Statutes (Must renew every 5 years).
  • The organization is registered with the Florida Department of Agriculture and Consumer Affairs, Division of Consumer Services, in accordance with Chapter 496, Florida Statutes, the Solicitation of Contributions Act. Organizations claiming exemption from the provisions of Chapter 496, Florida Statutes, must provide documentation supporting the exemption.
  • Letter showing current registration compliance with or exemption from Florida Department of Agriculture and Consumer Services.
  • The organization must submit a copy of its current fiscal year budget (i.e., FY 2016-2017).
  • The organization is governed by a volunteer board of directors that meets regularly and serves without compensation. (Compensation shall not be deemed to include payment of the reasonable expenses of service as a director, including liability insurance. The board of directors must direct policy development and implementation, retain oversight of program delivery, and exercise executive level supervision.)
  • The organization has a recognized on going and substantial program of health and human services directly benefiting the Alachua County region.
  • Documentation is required using the worksheet provided on the previous page, showing a detailed description of the goals and objectives of the programs provided, documentation of expenditures, and quantitative data on the number of people served in the Alachua County Region.
    Accepted file types: pdf, doc, docx.
  • Please attach any supporting documents such as agency audit, program brochures, annual report, or other information that describes your agency mission and performance.
  • The organization has a written policy of non-discrimination and carries out an affirmative action program that applies to volunteer governance, staffing, and clientele of the organization (all policies must meet requirements of state and federal law).
  • Please provide a copy of the written policy.
  • The organization must submit a copy of the organization's most recent IRS Form 990 or 990EZ as it was submitted to the IRS. If the Internal Revenue Service does not require your applicant organization to file an IRS Form 990, you must still complete and submit to campaign officials a signed copy of the 990 with the following pages completed: • Page 1, (Part I Summary and Part II, Signature Block), • Page 7 • Page 8, (Part VII Compensation sections A and B) • Page 9, (Part VIII Statement of Revenue), • Page 10 (Part IX Statement of Functional Expenses), and • Page 11 (Part X Balance Sheet). IRS Form 990 must be signed by authorized agency signatory; the preparer’s signature alone is not sufficient. This document does not have to have been submitted to the IRS but must be prepared per IRS regulations. It is acceptable to note on the IRS 990 that it was prepared “For UFCC Purposes Only”. Note that Part IX regarding functional expenses must be complete, with all entries ultimately adding to Column A.
  • National Charities Information Bureau (NCIB) and the larger non-profit community have set the following standard for non-profits: An agency should maintain management, general, and fund-raising costs at or below 25 percent of the total budget. To calculate the percentage, use numbers from the submitted 990. Add Part IX, Line 25-Column C (Management/Administrative Expenses) and Part IX, Line 25-Column D (Fundraising Expenses) and divide by Part I, Line 12 (Total Revenue). Please enter percentage below:
  • If the organizations management, general, and fund-raising costs exceed 25% percent of the total budget please set forth with particularity (in the space provided on the application or in an attachment), the facts you allege that constitute “extraordinary circumstances” and which justify your organization’s inclusion in the campaign. In addition, explain why these extraordinary circumstances could not have been avoided.
  • Please feel upload addition information if needed.
  • If your organization is represented by a federation, please select below. If not, please select independent. This designation is how your agency will be listed in our campaign literature.
    I, the undersigned, am the duly appointed and authorized representative of the above agency and hereby certify the accuracy and completeness of this application.