State Employee Charitable Campaign Affiliate Agencies

Important Information  Type your forms if possible; it offers a more professional presentation.  Applications should be 3-hole punched.  2 applications need to be submitted (The original & 1 copy)  Clearly mark your attachments! (Label or tab them.)  Deadline for submissions: 3/11/2011 at NOON!

Affiliate Information Page  Specify if your agency has participated before.  Fill out all information completely and accurately.  The 25 word statement is important! (Not only does SECC use this in their donor brochure, UWGCM uses this in our Agency Program Services sheet.

Affiliate Information Page (cont.)  Administrative expenses % for 2010, 2009 & (Administrative expenses + fund raising costs / total revenue = percentage for admin costs.  If you chose to have electronic funds transfer (EFT) instead of paper checks, please include your bank information at the bottom of the page.

25 Word Statement Example “Offers information and referral and provides for the health, welfare and character building for residents of the mainland of Galveston County through its partner agencies.” – United Way Galveston County Mainland

Attachment A “A letter indicating that the organization is organized for charitable purposes.” Secretary of State (State Seal)

Attachment B Department of the Treasury – 501 (c)(3) Letter “A copy of the Internal Revenue Service (IRS) determination letter indicating that applicant organization or affiliate is exempt from taxation.”

Attachment C A complete and signed copy of the IRS Form 990 for a period ended not more than 18 months prior to January 2011 (i.e. June 30, 2009)

Attachment D If affiliate’s budget does not exceed $100,000, attach an accountant’s review offering full and open disclosure of the organization’s internal operations. If affiliate’s annual budget exceeds $100,000, attach an independent audit completed by a certified public accountant.

Attachment E (if applicable) If an affiliate’s administrative expenses exceed 25% then you must attach a document entitled, “Explanation of Expenses and Plan to Reduce” that explains your plans to reduce these expenses and how it’ll be done. NOTE: It must be a one page document in 12- point size font.

Attachment G Letter stating that UWGCM (the federation) serves as the affiliate’s representative and fiscal agent. We have these available if you are in need of one.

Attachment L Affiliate Acknowledgement of Accountability This form is a part of the actual physical application.

Attachment L1 If a local charitable organization is applying under more than one federation in the statewide campaign, the organization must attach a document listing each federation under which it will apply. (i.e. United Way of Galveston, United Way of Brazoria County, etc.)

Questions? GOOD LUCK!