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Untitled Document
 
Designated Fund Letter of Intent
Any organization wishing to be a designated fund of the BACF must either be (a) identified by the IRS as a 501(c)(3) public charity (which is not a private foundation), described in sections 509(a)(1)-(4) of the Internal Revenue Code, (b) a governmental entity, or (c) a church or synagogue.

Organization Name:
Mailing Address:
City:
State:
Zip:
Contact Person:
Phone:
Email:
501(c)(3) Organization          Government           Church or Synagogue
 

If you chose 501(c)(3) Organization, Send in a copy of your IRS letter of determination. Please follow the Documentation link for more detailed instructions on information that will need to be provided to the Foundation prior to approval.

 
Mission

The Blair Area Community Foundation's mission is to support activities that enrich the community and support the values of the families that live in Washington County. Areas of support include education, fine arts, community betterment, parks and recreation, public facility development and improvements, health and welfare, and other charitable purposes.

 
Evaluation
 

1. Please describe what the designated funds will be used for:

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2. Describe how the proposed activity fits the Foundation's mission. (See "Mission" section above.):

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3. Does the proposed activity benefit the Foundation's service area of Washington County? Please be specific.

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4. What personnel, resources, and experience does your organization have available to ensure that the project will be carried out according to plan?

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5. List any restrictions to be placed on the distribution of the funds.

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Acknowledgement Agreement

The recipient agrees to indicate the assistance of the Blair Area Community Foundation in press releases, publications, and other public activities associated with the project.

 
Fund Withdrawal

Withdrawal of funds must be requested by the above named organization using the "Blair Area Community Foundation Disbursement Voucher" and providing acceptable documentation. It is understood, however, that in order to comply with Internal Revenue Service regulations, the final decision concerning fund withdrawals resides with the Blair Area Community Foundation.

Applicant's Signature and title:

Date: