1. Name and address of organization and its contact person:
2. Purposes of the organization:
3. Federal Tax ID Number (if any):
4. Proposed activities and/or fundraising efforts that will be conducted on behalf of the University or with the use of the University name, logo or facilities.
6. Attached copies of Internal Revenue Service Determination Letter of Non-Profit Tax status (if any); most recent financial statements for the organization or IRS 990 with this application. If the organization does not have financial statements, then please state the sources of funding for the organization and a summary of expenditures for operating purposes.
If approved, the Affiliated Support Organization agrees to the following:
· The Organization is responsible for and will comply with all applicable federal, state and local laws.
· If Affiliated Support Organization has not already entered into an agreement with the university, the organization agrees to enter into an appropriate Affiliation Agreement with the University.
· If an Ad Hoc fundraising event is approved, the organization is responsible to submit an accounting of the revenues and expenditures for the event(s) to the Internal Auditor signed by the party in the organization who can attest that the accounting is accurate.
· Affiliated Organization will not make any payments to faculty or staff except as allowed under Payment or Expense Reimbursement for University Employees by Affiliated Organizations at the following web address: _policy.htm].
Applicant Organization's Representative
Phone and email address:
Vice President date