Support Request Application

Experience Kissimmee Cares is accepting applications from non-profit organizations to be consider as a recipient of proceeds from one of our charitable events or programs. If your organization wants to be consider, please complete the following application. Your application will be reviewed and you will be notified if you are selected.

Contact Information

Full Legal Organization Name:
Address:
City:
State:
Zip:
Website:
President/CEO Name:
Email:
Phone Number:
Contact Person (if different):
Additional Contact Title:
Additional Contact Phone Number:
Additional Contact Email:

Organizational Information

501 (c )(3):	udf_1563 Yes No
If yes, EIN #:
Year Established:
If No, provide sponsor’s name, address and EIN #:
Total Organization Budget:
Fiscal Year:
# of Board Members:
# of F/T Staff:
#of P/T Staff:
# of Volunteers:
Organizational Mission Statement:
Brief Description of Organization:
Population Served:
Organization’s History:
Organizational Goals and Objectives:
Programs and Services:
Organizational Structure (Describe role of board, staff and volunteers):

Project Request

Project Name:
Total Project Budget:
Monetary Request Amount:	$
In-kind Donations or Service Request (Describe):
In-kind Value:	$

Additional Support Request Information

Description of Need (What is the issue you plan to address? What are the demographics and number of people you plan to serve, if applicable?):
Description of Request (List details of your request. How will the funds be used? Or, how will in-kind donations or services be used?):
Goals and Objectives for this Request (How will this support strengthen the organization, address the issues, make improvements and/or achieve success?):
Does this benefit the tourism community/industry and if so, how?:
How will Experience Kissimmee, Experience Kissimmee Cares or its Partners be recognized for the support?:
(What are the anticipated results? What methods will you use to measure your progress?):
Anything else you would like to add?:
	I hereby verify that the information provided is accurate to the best of my knowledge.
E-signature:
Title:
Date:

(Please enter the 4 character string shown in the box above.)

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Support Request Application