PERMOBIL FOUNDATION SPONSORSHIP APPLICATION

SPONSORSHIP APPLICATION
Funding Guidelines

Recommendations for Sponsorship funding include consideration of:
- Alignment with Permobil Foundation mission/strategies
- Critical need in the disability community
- History and/or relationship with organization
- Relationship to Permobil and/or Permobil employee(s)
- Organization’s budget needs
- Completed application and all required documentation
Application Deadlines:

Applications are due by the 20th of each month (no exceptions)

All event sponsorship requests must be submitted a minimum of
60 days prior to the event
- The Permobil Foundation Board of Directors meet once a month to consider donation, sponsorship, and grant requests.
- Applications are reviewed on a case-by-case basis. Proposals may, at the discretion of the Permobil Foundation and the Board of Directors, be either fully funded, partially funded, declined, or the organization may be asked to resubmit and provide additional information
- Funding for capital expenditures, ongoing expenses, administration and salaries are not an approved use of funds
- Please note that in-kind product donations are limited and are only given at the discretion of the Permobil Foundation and the Board of Directors
- The Permobil Foundation’s fiscal year is on the calendar year. The Foundation requests that only one application be submitted during a twelve-month period
- The Board of Directors make their decision based on findings and recommendations prepared for them by the Foundation staff
- All applicants will be notified of the status of funding their application
ORGANIZATION INFORMATION
Name of Organization/Agency: *
Does your organization/agency have a 501(c3) tax-exempt status: *

Yes No
Federal ID #:
Website
Address: *
City: *
State: *
Zip Code: *
Contact Name: *
Title:
Email: *
example@example.com
Phone #: *
Primary contact at Permobil:
Have you previously received funds from Permobil? *

Yes No

If yes, please provide additional information (date, funding amount, brief purpose of donation)

	Date	Amount	Purpose
1
2
3
4

Provide a brief overview of your organization's mission, date founded, national or local organization, etc: *
DONATION REQUEST: request must be a minimum of 60 days prior to your event

Please include a written narrative of your request that includes the following (limit 3 pages including itemized budget):
- Details about of your organization (mission, accomplishments, etc
- What are the key objectives/purpose of your request
- Who would benefit from your program
- If sponsorship benefits are involved include all levels/opportunities of support
- How will your organization use the funding (please include a itemized budget to support)
Briefly describe an overview of your request including date of event (limit to 3-5 sentences): *

Amount Requested *

	Amount
Total Requested
Total Funding to be raised
Funding date requested by
Funding from other sources

Please list all levels and brief detail of each Sponsorship level available *

Please list other contributors and amount of donation/sponsorship *

	Contributor	Amount
1
2
3

Please ensure the following are included with your proposal:
- Completed application
- Written narrative of your request including itemized budget
  and all levels of sponsorship opportunities (limit 3 pages)
- Copy of 501(C 3) IRS Approval
- C urrent form 990 or financial statement
- Current list of Board of Directors
- For additional information please email: Info@permobilfoundation.org
Written Narrative *

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Cancel of
501c3 IRS Approval

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Cancel of
Organization Financial Statement *

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Cancel of
Organization Board of Directors List

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Cancel of
Sponsorship Levels (upload sponsorship levels as well as complete section above) *

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Cancel of
Other

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Cancel of
Certification and Acceptance: I certify that information contained herein is true and complete and accept the obligation to comply with the terms and conditions if the request is awarded as a result of this application. I further certify that the organization named above currently has tax-exemption under the Internal Revenue Service Code Section 501(c3), that the Organization’s IRS determination letter has not been revoked. Non-Discrimination: The Permobil Foundation will not make contributions to groups that discriminate on the basis of race, color, religion, gender, mental or physical disabilities, sexual orientation, national origin, age, citizenship, veteran/reserve/national guard status or other protected status; partisan political organization; or groups limited to members of a single religious organization.
Signature of Representative

Clear
Title
Date

Month Day Year
Date
Should be Empty:

SPONSORSHIP APPLICATION

Funding Guidelines

ORGANIZATION INFORMATION