FSP Digital Application


 

Please complete all information in this form. If you need assistance, please contact our office at 571-620-3000.

PROGRAM INFORMATION

*Proposed Program Name and Charitable Mission are subject to approval.

Proposed Program Name  

Please select a Field of Interest from the list below:


Please indicate why this field of interest was chosen:


PROGRAM MANAGER INFORMATION

*May not be a contributor.

Full Name:  

Date of Birth:  

Street Address:  

City/State/Zip:  

Primary Phone: Cell Phone:

Email Address:  


ADVISORY COMMITTEE MEMBER INFORMATION

Full Name:  

Street Address:  

City/State/Zip:  

Primary Phone: Cell Phone:  

Email Address:  

 

ADVISORY COMMITTEE MEMBER INFORMATION

Full Name:  

Street Address:  

City/State/Zip:  

Primary Phone: Cell Phone:  

Email Address:  

 

ADVISORY COMMITTEE MEMBER INFORMATION

Full Name:  

Street Address:  

City/State/Zip:  

Primary Phone: Cell Phone:  

Email Address:  

*Please note, if you have additional committee members, please attach a separate document including their contact information. File extensions must be in jpg, gif, png, or pdf format.

 

 

FISCALLY SPONSORED PROGRAM PROPOSAL

If additional space is needed, you may attach a separate document.

  1. MISSION STATEMENT - Indicate the mission of your proposed program. This is a short, 3-5 line statement that will be used on your program's acceptance certificate, website listing, and other documents verifying the program's status as a fiscally sponsored program of United Charitable.

  2. DESCRIPTION - Include a description of your proposed program. It should be a full description of the proposed program activities along with its charitable goals and objectives.                                   



  3. NEED - The need you propose to address with your program. Your submission should include an evaluation of the needs of your community or geographic area and description of your community or constituency (ethnic/cultural configuration, economic/class, gender, disability, etc.).



  4. STRUCTURE - Include the structure of the proposed program. How do you intend to operate this program with regards to volunteers, office space, partnerships with other non-profits, staffing, equipment, etc.? Also, include the RESOURCES you may need to accomplish your program's charitable goals (development, technical assistance, and capacity-building) and how you plan to address those goals.



  5. FUNDRAISING ACTIVITIES - Indicate how you will meet your proposed objectives. What are the major fundraising activities and/or other development methods you plan to perform under the program to fund its charitable goals?



  6. EXPECTED OUTCOMES - What are the expected outcomes of your proposed project. What are the planned outcomes within the first year of operation? How long do you envision this program operating and what key indicators will you use to show improvement of success?



1 YEAR BUDGET 

Provide a 1-year Program Budget.

*Please note that Revenue and Expenses can vary depending on the Mission of the Program.


Revenue
Donations (Individual Donors, Corporate Donations, other)
Grants (Government, State, Private, other)
Events (Revenue from events held)

Other Revenue (Please explain):

Total Revenue
Expenses
Program Missions Expenses (Books, Supplies, Clothing, Toys)
Office Operations Expenses (Postage, Telephone, Rent)
Technology Related Expenses (Internet, Software, Computer Expense)
Human Capital Expenses (Employees, Contractors, Benefits)

Other Expenses (Please explain):

Total Expenses

Net Income (Revenue - Expenses)

 

STATEMENT OF UNDERSTANDING

I submit the following proposal for United Charitable's Board of Directors' review and consideration for approval. I certify that I have read and will comply with the Fiscal Sponsorship Agreement attached. Additionally, I indemnify United Charitable and hold its officers, directors, and members harmless from any liability whatsoever resulting from any claims, injuries, damages, or contractual liability of any nature whatsoever against the applicant. Indemnification includes, but is not limited to, personal injuries, misinformation, liability for sales or property taxes, licensing fees, rents, and lease expenses.

I understand that it may take up to six weeks for United Charitable to review this program application. I understand that if my program application is denied, $700.00 of my $1000.00 application dee will be refunded. I understand that a pro-rated annual fee will be assessed to the program if approved within 30 days of acceptance.

My signature below verifies that I have read, understand, and will comply with the above policies.

Program Manager Signature

Print Name

 

ITEMS FOR PROGRAM APPLICATION

*Please note: To be considered a complete Fiscally Sponsored Program Application, the following items must be completed and turned in.

APPLICATION FEE

Application fees can be paid by credit card here:

https://www.unitedcharitable.org/fsp-application-fee/

*Please note, online credit card payments will incur a 3% processing fee.

Or

Mail checks to:

United Charitable

P.O. Box 715969

Philadelphia, PA 19171-5969

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: FSP Digital Application
lock iconUnique Document ID: 790a82c282d053bffd2f48531d1479555d54d30b
Timestamp Audit
January 20, 2021 4:33 pm ESTFSP Digital Application Uploaded by Fiscal Sponsorship - fsp@unitedcharitable.org IP 72.73.25.226
January 22, 2021 3:42 pm ESTVanessa Connelly - vanessa@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 71.191.82.237
January 22, 2021 3:42 pm ESTIsaac Leeth - isaac@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 71.191.82.237
March 21, 2022 2:43 pm ESTVanessa Connelly - vanessa@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
March 21, 2022 2:43 pm ESTIsaac Leeth - isaac@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
March 21, 2022 2:45 pm ESTVanessa Connelly - vanessa@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
March 21, 2022 2:45 pm ESTIsaac Leeth - isaac@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
March 21, 2022 2:51 pm ESTVanessa Connelly - vanessa@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226
March 21, 2022 2:51 pm ESTIsaac Leeth - isaac@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226