To be eligible for participation in the 2018 campaign, your application must be postmarked by May 1, 2017. If you are currently a participating One Gift agency, you do not need to reapply each year. Agency Information Agency Name: Name of Contact Person: Contact Title: Contact Email: Street Address/PO Box: City: Zip: Contact Phone Fax Number: Number: Agency Website: Employer Identification Number (EIN): Is your EIN shared with any other Yes No If yes, please identify the agencies: agency? Federation Information Is your agency part of a federation or parent organization? Yes No If yes, please identify: Is your agency a Yes No federation? If yes, please list all your participating agencies below. (Attach additional sheets if necessary.) Information about Iowa Clients List the approximate number of clients your agency served in Iowa during your most recent fiscal year: # (number of clients)
To be eligible for participation in the 2018 campaign, your application must be postmarked by May 1, 2017. If you are currently a participating One Gift agency, you do not need to reapply each year. Agency Information Agency Name: Name of Contact Person: Contact Title: Contact Email: Street Address/PO Box: City: Zip: Contact Phone Number: Fax Number: Agency Website: Employer Identification Number (EIN): Is your EIN shared with any other agency? Yes No If yes, please identify the agencies: Federation Information Is your agency part of a federation or parent organization? Yes No If yes, please identify: Is your agency a federation? Yes No If yes, please list all your participating agencies below. (Attach additional sheets if necessary.) Information about Iowa Clients List the approximate number of clients your agency served in Iowa during your most recent fiscal year: # (number of clients)
One.Gift.Agency.Application-2018.docx