Rounding Up at the Register Application

Name of Organization*

501(c)3 Number:

Which KWF location is geographically closest to your organization or service area?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name*

First Last

Phone*

Email*

Website*

Rounding Up at the Register Agreement

*

I have read and understand the statement below.

The following will not be considered for Rounding Up at the Register: individuals, political campaigns, religious organizations*, K-12 schools, sports teams, for-profit businesses. Past support through an in-kind donation or sponsorship from Kimberton Whole Foods does not guarantee selection, nor does being previously selected for the Rounding Up at the Register program.

*An exception to this is a food pantry or farm operating under a religious organization, in which case the donation will be earmarked for that operation.

Organization Overview

What is the mission of your organization?*

What services do you provide to the community?*

Who benefits from your services?*

Do you offer free or discounted services?*

Does your organization receive grants or state funding?*

Describe your primary sources of funding:*

How would the donation from Rounding Up at the Register benefit your organization and what programs would the funds be allocated to?

Is there any other information we should know while considering your organization?