Moody Cares Charitable Donation Application Charitable Donation Application Request Welcome to the Moody Cares Charitable Donation Request. In order to have your request reviewed, you must complete the entire application. Applications can be submitted throughout the year. OK Question Title * 1. Organization Name OK Question Title * 2. Physical Address OK Question Title * 3. Mailing Address OK Question Title * 4. Phone Number OK Question Title * 5. General Email OK Question Title * 6. Organization Website OK Question Title * 7. Tax ID Number OK Question Title * 8. Executive Director Name OK Question Title * 9. Executive Director Phone OK Question Title * 10. Executive Director Email OK Question Title * 11. Direct Contact Name OK Question Title * 12. Direct Contact Phone OK Question Title * 13. Direct Contact Email OK Question Title * 14. What is the mission of your organization? OK Question Title * 15. Organization Type Arts, Culture, Humanities Environment/Animals Homeless Prevention Affordable Housing Education Health Human Services Religion OK Question Title * 16. Population Benefited General Population-General/Unspecified Poor, Economically Disadvantaged, Indigent Unemployed, Underemployed, Dislocated Veterans Homeless At Risk Populations Elderly and/or Disabled LGBTQ Families Immigrants, Newcomers, Refugees OK Question Title * 17. Age Group Benefitted General/Unspecified Infant to Preschool Grade School (6-13 years old) High School (14-18 years old) Adults 18+ Seniors 65+ OK Question Title * 18. Gender Served Unspecified Males Females OK Question Title * 19. How many clients did your organization serve in the last fiscal year? OK Question Title * 20. What is the percentage of the clients that are low to moderate income (LMI)? OK Question Title * 21. What geographic areas do you serve? Select all that apply. Galveston County Harris County Brazoria County Fort Bend County Travis County Comal County OK Question Title * 22. Request Summary Capital Campaign Program/Project Support General Operations OK Question Title * 23. Request/Project Title OK Question Title * 24. Request Summary OK Question Title * 25. History of the organization OK Question Title * 26. What are your expected outcomes for the project? OK Question Title * 27. Provide any details about partnerships and collaborations the project or organization currently has. OK Question Title * 28. What is the expected timeline for the program or project? OK Question Title * 29. What is the project budget total? OK Question Title * 30. Amount being requested and event date OK Question Title * 31. What are other sources of funding for the project? OK Question Title * 32. Does your organization have volunteer opporutnities for Moody Bank employees? Yes No OK Question Title * 33. If so, who is the primary contact for volunteers? OK Question Title * 34. Volunteer Email OK Question Title * 35. Volunteer Phone OK Question Title * 36. I certify the that the information contained in this sponsorship application is true and correct to the best of my knowledge. Name Title Date OK Thank you for completing the Moody Cares Charitable Donation Application. You will be notified in 6 to 8 weeks via email on the status of your application. OK DONE