Legal Name of Organization
Contact Best Phone Number
Phone Number Type
Address (Street, City, State and Zip Code)
If you answer "NO" to any of the application 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 April 17, 2024.
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?
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 (as reflected by your current Annual Report being filed and available on the Florida Sunbiz website)?
Is your organization registered with the Florida Department of Agriculture and Consumer Services (required of all charities soliciting in Florida, excluding religious, education and government entities)?
Please provide your FDACS Charity Number.
Has your organization been in operation for a minimum of 24 months and able to provide Financial Statements and Tax Returns for that period?
Is your organization free of legal actions declared, including current and pending conflicts?
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”.
Will the Initiative you seek funding for primarily serve and benefit the communities and residents of Sarasota and/or Manatee Counties?
Is the Initiative you are seeking funding for a new project, program, or capital expense or a significant, clearly defined expansion of an existing project, program, or capital expense? An expansion must be clearly defined by a significant increase in the population served, a broadening of the offering to a different population category or a broadening of the type of service offering. For an expansion, only the direct operating expenses that support the expansion will be funded. A continuation of an existing program or service offering is not eligible for an Impact100 SRQ grant.
Will you expend the full amount of the requested grant funds within the 24-month grant period that begins on the January 2025 award date?
If your Initiative is a capital improvement or renovation to property, do you own the property or have a written property lease or other valid written agreement that you can provide that demonstrates the permission of the property owner to fully implement the Initiative?
Please let us know in which Focus Area you intend to apply. Please keep in mind that your Initiative should align with your choice of Focus Area.
Impact100 SRQ will not provide grants for:
Please confirm that you will be able to verify and provide supporting proof of above, if applicable, during the grant application review process.
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 Application Eligibility Form does not guarantee eligibility or funding.
Impact100 SRQ reserves the right to change its Grant Eligibility Guidelines without notice at any time.