2023 Grant Eligibility Form

Thank you for your interest in our 2023 Grant Application. To determine your eligibility to receive the Grant Application, please submit this Eligibility Form no later than June 9, 2023. An automatic acknowledgment of your submission will be forwarded to you from the Action-Impact100 SRQ email address. If you do not receive it, please check your spam folder.

If your eligibility to receive the Grant Application is confirmed, you will receive an email with the link to the Application. The Grant Application will be available on March 22, 2023. If your eligibility is confirmed before March 22, 2023, you will be notified of your confirmation but you will not receive the link to the Application until that date. On March 21, 2023, we will announce our 2023 Giving Year membership numbers which will determine how many Grants we will award and each Grant’s dollar amount. The last day to submit the Grant Application is June 14, 2023 at 12 NOON Eastern Standard Time.

Please note that only eligibility to submit an application will be confirmed through the information provided, and submission of this Eligibility Form does not guarantee eligibility or funding.

First Name *

Last Name *

Email *

Contact Information

Legal Name of Organization

Contact Name

Contact Title

Contact Email

Contact Best Phone Number

Phone Number Type

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Address (Street, City, State and Zip Code)

Eligibility Questions

If you answer "NO" to any of the eligibility questions, you may or may not be eligible to apply for this Grant. We will review the information you provide. If your eligibility is confirmed, you will receive a link to the Grant Application starting March 22, 2023.

Is your organization a tax-exempt public charity under Section 501(c)3 of the Internal Revenue Code? If “No”, does your organization have an application for 501(c)3 status pending approval by the IRS?

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Please enter the EIN as stated on the IRS Department of the Treasury letter classifying your organization as a public charity.

Is your organization registered with the Florida Division of Corporations as a nonprofit organization?

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Has your 2022 Annual Report been filed with the Florida Division of Corporations and is it reflected on the Florida Sunbiz website?

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Is your annual registration with the Florida Department of Agriculture and Consumer Services (required of all charities soliciting in Florida, excluding religious, education and government entities) complete?

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Please provide your FDACS Charity Number.

What is the expiration date of your FDACS Charity Number? (MM/DD/YR)

Has your organization been in operation for 24 months and are you able to provide Financial Statements and Tax Returns for that period?

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Is your organization free of legal actions declared, including current and pending conflicts?

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If you answered “No” to the question "Is your organization free of legal actions declared, including current and pending conflicts?", please explain why you answered “No” and how it relates to your organization.

Will the Initiative you seek funding for primarily serve residents of Sarasota and/or Manatee Counties?

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Is the Initiative you are seeking funding for a new project/program/capital expense or a significant, clearly defined expansion of an existing project/program/capital expense? A continuation of an existing program is not eligible for an Impact100 SRQ Grant.

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Will you expend the full amount of the requested funds within 24 months of the November, 2023 Award Date?

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If your Initiative is a renovation or capital improvement to property, do you own the property or have a written lease or other valid written agreement for at least five years with the property owner/landlord that you can provide?

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Please let us know in which Focus Area you intend to apply. Please keep in mind that your Initiative should align with your mission and therefore so should your choice of Focus Area.

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We will not provide grants for:
• Debt reduction, operational deficits, interim funding, bridge funding or endowment funding
• General operating expenses, overhead expenses, and ongoing salaries for existing staff that support the organization’s current operations and programs. Only direct operating expenses that support the new or expanded initiative will be funded by Impact100 SRQ. Detailed allocation of funds is required
• Grants to individuals
• Any type of arrangement whereby funds are held temporarily or in perpetuity and not expended within the 24-month period required by Impact100 SRQ
• Partisan, legislative, or political activity or any activity that could be controversial, divisive or polarizing in nature
• Initiatives of individual religious institutions will not be funded unless a separate tax-exempt entity that is not under the umbrella of the religious institution exists for receiving Impact100 SRQ funds
• Initiatives not available to any person, regardless of religious beliefs or practices or any person being required to participate in any religious activity, ceremony or service
• Capital improvements or renovations to property for the grant initiative if the organization does not own or have a written lease or other valid written agreement of at least five years with the property owner/landlord.
• Grant recipients of an Impact100 SRQ grant awarded in the last two grant cycles.

You must be able to confirm, verify, and provide supporting proof of above, if applicable, during the grant application review process.

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Verification

I confirm that, to the best of my knowledge, all responses are accurate and have been approved by our organization's Executive Director or Board Chair.

Please note that only eligibility to submit an application is confirmed through the information provided, and submission of this eligibility form does not guarantee eligibility or funding.

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As we continue to grow and evolve, Impact100 SRQ reserves the right to change its eligibility criteria without notice at any time.