Sponsored Agency Certification I certify that we wish to have the above named fiscal sponsor, and we agree to the terms as a subrecipient of the fiscal sponsor. To the best of my knowledge and belief, all information in this application is true and correct. Name of Sponsored Organization Name of Authorized Official Title Date Signature Fiscal Sponsor Application Required Documents Fiscal Sponsor Applications must be received by 4:00pm on Monday, September 17, Applications should be submitted as one hard copy, including the original Fiscal 2018. Sponsor Application, and one flash drive to the NC ESG Office. All applications received by this deadline will be reviewed. Late applications will not be reviewed. Fiscal Sponsors will be notified of a decision by the NC ESG Office no later than September 24, 2018. If approved, this application must be included with the LPA Regional Application. Unit of Local Nonprofit Government TAB Document Fiscal Sponsor Fiscal Sponsor Applicant Applicant Signed, Completed Fiscal Sponsor Application 1 (Word Document) Current year operating budget (with Revenues and Expenditures) showing reserves to cover the - 2 organizations your agency is sponsoring. Organizational Chart - 3 List of names, email addresses, telephone numbers, occupations, with officers identified. - 4 Indicate homeless or formerly homeless BOD member. Your the audit for your most recent closed agency’s most fiscal year OR - 5 If you do not have an audit, use the provided sworn financial statement form, the Organizational Budget (budget vs. actual revenue and expenses), and the
Sponsored Agency Certification I certify that we wish to have the above named fiscal sponsor, and we agree to the terms as a subrecipient of the fiscal sponsor. To the best of my knowledge and belief, all information in this application is true and correct. Name of Sponsored Organization Name of Authorized Official Title Date Signature Fiscal Sponsor Application Required Documents Fiscal Sponsor Applications must be received by 4:00pm on Monday, September 17, 2018. Applications should be submitted as one hard copy, including the original Fiscal Sponsor Application, and one flash drive to the NC ESG Office. All applications received by this deadline will be reviewed. Late applications will not be reviewed. Fiscal Sponsors will be notified of a decision by the NC ESG Office no later than September 24, 2018. If approved, this application must be included with the LPA Regional Application. TAB Document Nonprofit Fiscal Sponsor Applicant Unit of Local Government Fiscal Sponsor Applicant 1 Signed, Completed Fiscal Sponsor Application (Word Document) 2 Current year operating budget (with Revenues and Expenditures) showing reserves to cover the organizations your agency is sponsoring. - 3 Organizational Chart - 4 List of names, email addresses, telephone numbers, occupations, with officers identified. Indicate homeless or formerly homeless BOD member. - 5 Your agency’s most the audit for your most recent closed fiscal year OR If you do not have an audit, use the provided sworn financial statement form, the Organizational Budget (budget vs. actual revenue and expenses), and the -
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