FSP Digital Application
Please complete all information in this form. If you need assistance, please contact our office at 571-620-3000.
*Proposed Program Name and Charitable Mission are subject to approval.
Proposed Program Name
Please select a Field of Interest from the list below:
Arts & CultureEmergency AssistanceEducationAnimal WelfareEnvironmentLegal/Civil RightsWomen's IssuesHealth/DisabilitiesFamily ServicesChildren/YouthReligious/MinistryVeterans/Military Affairs
Please indicate why this field of interest was chosen:
*May not be a contributor.
Date of Birth:
Primary Phone: Cell Phone:
Primary Phone: Cell Phone:
*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.
If additional space is needed, you may attach a separate document.
Provide a 1-year Program Budget.
*Please note that Revenue and Expenses can vary depending on the Mission of the Program.
Other Revenue (Please explain):
Other Expenses (Please explain):
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
*Please note: To be considered a complete Fiscally Sponsored Program Application, the following items must be completed and turned in.
Resume of Program Manager Signed Program Manager Job Description Resume of 3 Advisory Committee Members Signed Advisory Committee Job Descriptions $1,000.00 Application Fee
Application fees can be paid by credit card here:
*Please note, online credit card payments will incur a 3% processing fee.
Mail checks to:
P.O. Box 715969
Philadelphia, PA 19171-5969
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: FSP Digital Application
Agree & Sign