Round Up Application

Application for Grant

For Organization/Agency

The Energy Cooperative Round Up Foundation, Inc.

1500 Granville Rd. P.O. Box 4970 Newark, OH 43058-4970

Round Up Application

  • A copy of financial statement(s) for most recent year shall be provided. Please submit your most recent Form 990 or Audit Report. We request the provided information include a detailed balance sheet and income statement for the most recent completed fiscal year.
  • The information contained in this statement is for the purpose of obtaining funding from The Energy Cooperative Round Up Foundation, Inc. on behalf of the undersigned. Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and complete and that The Energy Cooperative Round Up Foundation, Inc. may consider this statement as continuing to be true and correct until a written notice of a change is provided. The Energy Cooperative Round Up Foundation, Inc. is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein. Please note that for the organization or agency who receives funding: 1) The Energy Cooperative Round Up Foundation, Inc. publishes the name, amount and purpose of funding granted. You may also be asked for a photograph for public relations purposes. 2) We also ask that you provide the Foundation with information to substantiate the use of funds awarded, such as copies of invoices, pictures of equipment purchased, or a statement describing specifically how the funds were used.
  • * In extreme circumstances and by a vote of the entire Board, this amount can be increased.
  • The verification portion of this form eliminates annoying SPAM submissions. By filling in the field with a number, we can verify that this form has been submitted by a legitimate source.