ACT's Giving Program Application

ACT Corporate Giving

Application Form

Before completing this form, please review the Corporate Giving Program Guidelines and Procedures to see if you qualify. You will be required to submit both a W-9 and a copy of your IRS tax exemption letter to be able to complete this request. Send PDF documents to corporate.giving@act.org.

Applications will be reviewed through June 1, 2024 for the current round of funding.

Fields marked with an asterisk (*) are required.

Deadline for funding decision (please apply at least 60 days prior to deadline):*

deadline

Section 1: Applicant Information

Organization Name*

Organization type, e.g., 501(c)(3)*

Organization Type (If you selected "Other")

Street Address*

City*

State*

ZIP Code*

Tax Payer ID*

Organization Contact Name*

Organization Contact Position/Title*

Organization Contact Email*

Organization Contact Phone Number*

Alternate Contact Name*

Alternate Contact Position/Title*

Alternate Contact Email*

Alternate Contact Phone Number*

Section 2: Project Information

ACT has the sole discretion to determine what funding to provide, if any. Typically, those selected for funding request and receive less than $5,000.

Project/Event Title*

Number of individuals impacted by your organization*

Project/Event Start Date*

Project/Event End Date*

Event Location (address, city, state)

Event Date (if different than project date)

Event Start Time

Event End Time

Total Project Amount*

Amount Requested from ACT*

Other Sources of Funding (amounts to be provided by other sources in addition to amount being requested of ACT.)

Source Name

Source Amount

Status

Source Name

Source Amount

Status

Source Name

Source Amount

Status

Source Name

Source Amount

Status

Source Name

Source Amount

Status

Section 3: Project Description

Please refer to guidelines regarding funding restrictions. The ACT Corporate Giving Committee (CGC) can only grant awards to applicant organizations once each fiscal year (ACT’s fiscal year runs September to August). Therefore, if organizations desire funding for more than one event or project in a given fiscal year, they are strongly encouraged to submit a single funding request for all events or projects rather than multiple requests throughout the year.

ACT Special interest area impacted (check all that apply)*

Local Education

Community Betterment

Human and Social Needs

Disaster Relief

Cultural and Artistic Enrichment

Diversity and Inclusion

Will you use the ACT logo for promotion of your project/event?*

Yes

How did you hear about the ACT Corporate Giving Program (check at least one)?

ACT Website

Center for Equity in Learning Website

Social Media

ACT Employee

News Article

Previous Experience

Other

If an ACT Employee, please provide their name and involvement with your organization:

Reminder

Before clicking ‘submit,’ please make sure you provide W-9 and 501(c)(3) documentation. Send PDF documents to corporate.giving@act.org.

ACT's Giving Program Application

Form submitted successfully

ACT Corporate Giving

Application Form

Section 1: Applicant Information

Section 2: Project Information

Section 3: Project Description

Reminder