Registration Form


Please complete the form below and click 'Submit' when you are done.

The IRS Federal Employer Identification Number (EIN) is a 9 digit number (format: XX-XXXXXXX). Do not fill with Florida state tax exemption number.
Has your organization qualified as a nonprofit, tax deductible entity, under the United States Internal Revenue Code 501(C)(3)? If "No", please enter application date and provide a copy of your organization's IRS for 1023


Total amount requested should not exceed $15,000
Please provide a clear and concise statement of how these funds will be used. Do not defer your statement to other attachments included with this application.
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In addition to providing the information in this form, please include with your request the following attachments. Failure to include the listed attchments will result in your application being declined and having to restart this process.

  1. Proof of the organization’s 501(c)(3) status
  2. Most recent financial statement (audited statement preferred)
  3. Most recent IRS form 990
  4. Operating budget for the current fiscal year
  5. Supporting documents regarding how funds will be used

To upload a file, Choose File, wait for file name to appear in line below, then select Upload File. The file name should then appear in the Uploaded Files list.

I hereby certify that the aforementioned and enclosed information is complete and accurate and that the organization is in full compliance with all applicable laws, statues, ordinances, rules and regulations of any applicable governmental authority, including laws prohibiting support of terrorism.

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