Emergent Needs Fund Application

An emergent need arises unexpectedly and requires prompt attention.

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Organization Name *

Email Address *

Address *

Phone Number *

Which Children’s Trust Goal or Strategy does your program address? 1. Children and youth are healthy and have nurturing caregivers and relationships. 2. Children and youth can learn what they need to be successful. 3. Children and youth live in a safe community. *

Are you a current Children’s Trust provider? Yes or No *

If not, have you ever received funding from the Trust?

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Name of the program you received funding for previously. *

Have you applied for Emergent Needs Funds before? Yes or No *

If you answered yes above please enter date.

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Is your business currently registered with the Philanthropy Hub? Yes or No *

Are you qualified to conduct business in the State of Florida? Yes or No Please attach your Sunbiz. *

Describe your program including how your services impact the lives of the Children of Alachua County. *

Please Specify your need in as much detail as possible. Include the dollar amount of your request. Explain how your request is an emergent need. *

What dollar amount are you requesting? *

What steps have you taken to resolve the need on your own? *

How has the emergent need impacted your service delivery? *

Please provide your organization's most recent audited Financial Statements if applicable. *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.

Please provide your organization's most recent financial statement to your Board of Directors. *

Files must be less than 2 MB.
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Please provide your annual report if applicable. *

Files must be less than 2 MB.
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Please provide your organization's current budget. *

Files must be less than 2 MB.
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Please upload your Sunbiz. *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc.

Name of the submitter *

Signature *

Emergent Needs Fund Application

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