2025 Unity Campaign Application

Organization Name

Organization Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Mailing Address (if different)

Agency Phone

Organization Mission Statement

Impact Area

Primary Contact's Information

Primary Contact's First Name

Primary Contact's Last Name

Primary Contact's Phone

Primary Contact's Email Address

CEO or Executive Director Name

First

Last

CEO or Executive Director Phone

CEO or Executive Director Email

Board Chair Name

First

Last

Board Chair Phone

Board Chair Email Address

Organization Information

Organization's Primary Client Needs

Which Eastern Panhandle counties does the organization serve? (select all that apply)

Berkeley

Jefferson

Morgan

Has your organization filed an IRS Form 990 within the last 18 months?

If no, explain.

Upload Copy of 501(c)(3) Tax Exemption Letter from the IRS

Schools and government agencies: To bypass the field, please submit a signed letter stating that your organization is a school or government agency.
Upload requirements

Does your organization have a diversity, equity, and inclusion statement?

Logo

Upload requirements

Project Information

Project Name

Project Type

Project Description

Unity Campaign Goal - Total number of dollars that you plan to raise through your organization's participation in the Unity Campaign.

Client Impact Story

Photo Supporting Client Impact Story

Upload requirements

Photo Description

List the total number of unique clients that you expect to serve with Unity Campaign funding.

Terms and Commitment

I agree to the 2025 Unity Campaign Eligibility Criteria and Guidelines.

I agree to the 2025 Unity Campaign Fundraising Policies and Guidelines.

Signature

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