Donation/Sponsorship Request Form

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Donation Request Amount:
Name of Agency:
Full Address:
County:
Chief Executive Officer:
Agency Contact:
Phone Number:
Email Address:
Website URL:

Is your organization a designated 501(c)(3)?
Yes
No
Tax Identification Number:
Relationship with Broadway Bank:
Customer Relationship
Board Relationship/Committee Member
Previous Recipient of Donation/Sponsorship
Is your organization a United Way Agency?
Yes
No
Briefly describe the mission of your organization:

Grant Purpose:
Official name of event/opportunity:
Date of event/opportunity:
How will the funds be used?:
Assist in providing affordable housing for low- to moderate-income (LMI) individuals?
Yes
No
Provide community services targeted to LMI individuals?
Yes
No
If YES, what percentage of clients served are LMI?
If YES, describe how the agency determines clients are LMI (for example, HUD guidelines, Medicare, School Lunch Program, income verification, etc.):
Help to promote economic development by financing small businesses?
Yes
No
If YES, approximately how many small businesses do you anticipate serving with this grant?
Assist in the revitalization or stabilization of LMI geographies?
Yes
No
Additional notes:
Sponsorship benefits:

Volunteer Opportunities:
Do you need bank volunteers to assist with this project?
Yes
No
Required documentation:
After your request is submitted, an automated email will be sent to the Agency Contact e-mail Address address you provided. Please reply to the message and attach the supporting documents listed below.
- IRS letter certifying 501(c)(3) tax-exempt status
- Agency Overview
- List of Agency Program
- List of Agency Board of Directors
- Most recent year-end audited financial statements
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