Home Financial Aid Application Form

Financial Aid Application Form

Instructions

The application will take approximately one hour to complete. The purpose of this form is to gather information that will help us decide if your organization is eligible for Kairos Capital funding.

Important! The information you provide to us must be accurate and approved by your Executive Director or Chief Financial Officer.

Note that this e-form is also available in PDF format. You can download the form by clicking here, or browse our download section.

Please make sure that you fill in all fields before you submit the form.

General Information
Name of Organization:
Address:
City | State | Zip Code:
Country:
Telephone:
Fax:
E-mail:
Website:
Primary Contact
Name and Title:
Name and title of primary contact within your organization.
Telephone (direct):
Fax:
E-mail:
Preferred Method of Contact: PostFaxE-mail
Background Information
1. Please state your organization's mission/purpose.
2. Please describe the activities your organization is involved in and the nature of your charitable work in less than 125 words. Please include details of the direct benefactors of your organization.
3. Please describe the historical, social and culteral circumstances leading up to the founding of you organization. What is your role and how has it developed over time?
4. Please provide the year in which the organization was incorporated.
Year:
5. Please provide the country/region in which the organization was incorporated.
Country/Region:
6. Does your organization have affiliates, chapers, subsidiaries and/or other related entities?
YesNo
If yes, (a) please provide a list of the names and addresses of these organizations and/or businesses and (b) brieflt describe the nature of the relationship with the above. If applicable, please include program, financial, fundraising and/or governing board relationships.
7. What is the scope of your organization's fundraising activities?
InternationalNationalLocal
Staff and Governance
8. Total number of employees, insert '0' if none exists.
Full-time:
Part-time:
9. Total number of volunteers (both full-time and part-time), insert '0' if none exists.
Volunteers:
10. Name and official title of the most senior salaried executive.
Name and Title:
11. Please identify the total compensation of your organization's most senior salaried executive in the last year. This total should include annual salary and, if applicable, benefit plans, expense accounts and other allowances. If this person is not the highest-paid executive, please also provide the name, title and compensation for that person.
Total Compensation:
12. Please provide details of the Chairman, General Manager or Manger Director.
Name and Title:
Address:
City | State | Zip Code:
Country:
Telephone:
Fax:
E-mail:
13. Does your organization have a board policy?
YesNo
14. Does the board of directors, management or a committee of the board receive, on an annual basis, the following documents?
Most recent audited/unaudited financial statmentsYesNo
Project Review (if one was issued)YesNoN/A
15. Does your organization have a board policy af assessing the organization's performance and effectiveness and of determining future actions required to achieve its mission?
YesNo
If your organization have a board policy of measuring effectiveness, how ofen are assessments carries out?
Frequency:
16. Does your organization submit a written report to its governing body outlining the results of the aforementioned performance and effectiveness assessments?
YesNoN/A
If your organization does submit a written report to its governing body, does the report include recommendations for the future actions?
YesNoN/A
17. Does the board of the directors formally approve the annual budget?
YesNo
18. Approximatly how many monts after the close of your organization's fiscal year are your audited financial statements complete?
Number of Months:
Operational Costs and Self-sustainable Businesses
19. Please describe the development and/or fundrasing methods employed by your organization in the past year.
20. Do you currently operate or plan to operate a business or investment for self-sustainability
YesNo
Please upload a business plan for which the requested funds will be used.
Upload:
21. If your organization has a website, please provide the Internet address for the specific page where each piece of information can be found.
Annual operating expense total:
Total Fixed Costs (e.g. building management and staff):
Total Variable Costs (e.g. electricity and transportation):
Organization's mission statment:
Most recent finincal information:
Organization's mailing address:
22. Is any of the information you have provided regarded as ″sensitive″ by your organization?
YesNo
23. Can the information you have provided be showcased on our website to raise awareness?
YesNoDepends
Please specify.
Please provide pictures capturing the projects that you raise funds for.
Upload:
Upload:
Upload:
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