2021 Oregon CFD Application

2021 CFD Funds & Federations Application

Pursuant to the provisions of Oregon Administrative Rules, Chapter 125, Division 30, the following fund or federation hereby applies for participation in the 2021 State of Oregon Employees’ Charitable Fund Drive (CFD).

FUND/FEDERATION INFORMATION:

* Indicates required field

Fund or Federation Name: *

Address: *

Line 1

Line 2

City

State

Zip Code

Country

EIN Number: *

Website: *

Oregon County Service Area(s): *

FUND/FEDERATION CONTACTS:

Primary Contact Name: *

First

Last

Phone Number: *

Email: *

Fiscal Contact Name: *

First

Last

Phone Number *

Email *

PUBLIC ACCOUNTABILITY STANDARDS:

Please describe your activities, including types of solicitation for contributions: *

Based upon the most recently filed IRS Form 990, indicate the percentage of total revenue applied to the areas of functional expense:
To calculate the percentages using the 990, add the amount in Part IX (Statement of Functional Expenses), Line 25, Column C (Management and General Expenses) to the amount in Line 25, Column D (Fundraising Expenses), and divide the sum by Part VIII (Statement of Revenue), Line 12, Column A (Total Revenue).

• Charitable purpose (programs/services): *

• Cost of solicitation (fund raising): *

Administration fee: *

Attach a copy of the most recently filed IRS Form 990 or 990EZ. The Form 990 must be for the fiscal year ending not more than 18 months prior to January of your campaign year.

Upload 990 File: *

Max file size: 20MB

By submitting this application, I certify that the information provided is true and correct, and the fund or federation I represent:

Has the permission of the member agencies submitted to represent them in the 2021 State of Oregon Charitable Fund Drive.
Agrees to inform the CFD managing organization of any changes in the list of eligible agencies and to submit a final list electronically to Oregon CFD at oregoncfd@unitedwaymwv.org no later than June 30, 2021.
Will readily provide upon request for each member agency the report required by the Public Accountability Standards under Oregon Administrative Rule 125-030-0041.
Has determined that all member agencies represented satisfy the standards set forth in Oregon Administrative Rule 125-030-0041.
Agrees to comply with Oregon Administrative Rules, Chapter 125, Division 30, and the policies and procedures established by the State of Oregon Charitable Fund Drive Committee.

Submit