Name of Organization(Required) Is your organization determined by the Internal Revenue Service to be a tax-exempt 501(c)(3) organization?(Required) Yes No Tax ID Number(Required) Executive Director(Required) Phone(Required)Primacy Contact(Required) Phone(Required)Email(Required) Physical Address(Required) Street Address Address Line 2 City ZIP Code Mailing Address(Required) Street Address Address Line 2 City ZIP Code Website Submission Date of Request:(Required) MM slash DD slash YYYY Date donation is needed(Required) MM slash DD slash YYYY Have you read the First National Bank Alaska Charitable Contribution Guidelines?(Required) Yes No Has your organization received charitable contributions from First National Bank Alaska within the past 2-3 years?(Required) Yes No If YES, your organization received support in the past, provide insight as to the impact made by First National’s last contribution to your organization:Mission statement of your organization:(Required)Brief description of your organization (history, program or major activities):(Required)Are you (the nonprofit seeking donation) a First National Bank Alaska customer?(Required) Yes No This is not required for consideration of this request.Which bank officer / employee can speak on behalf of this request? This is not required for consideration of this request.Specific amounts / items requested (include dollar amount, etc.)(Required) Select the First National Bank’s primary focus area(s) the proposed charitable donation would support:(Required) Youth Education Basic Emergency Services Other Area of Interest If "Other Area of Interest," please describe the area of interest: Describe why the funds are needed (total project costs versus amount requested):(Required)How will any other funds needed be raised from other organizations?(Required)Describe how and when the funds (or items) will be used:(Required)* Which community or neighborhood in Alaska will benefit from this donation?(Required) * How many individuals were served by your organization last year?(Required) * How many will be served through this donation?(Required) * Does your program target low- to moderate-income audiences?(Required) Yes No * Are 51% or more of your clients determined to be coming from households with qualified low or moderate-incomes (HUD annual gross household income limits set at or below 80% area median incomes adjust by household size for the applicable county or borough of residence)?(Required) Yes No * How do you determine and track the income level of program recipients in low- to moderate-income brackets?(Required)If requested, what documentation can you provide in support of the statements in the starred sections above? (such as numbers and income level served, no specific client names or data required)(Required)How will the bank’s donation be acknowledged?(Required) Important! Your application will not be considered complete without these supporting documents. Current active Alaska business license and completed IRS form W-9 Current expense statement and current budget Current list of board of directors Most recent annual report and IRS 990 filing (if no annual or financial audit report is available) For event sponsorship requests, also provide all of the following, if applicable: A listing of all available sponsorship levels and associated benefits A list of current funder commitments Any pending requests with other funders For annual events: list of previous year’s funders and, if available, historical information on event goal versus actual funds raised (optional) Any other documentation your organization would like considered (optional) How to submit required documentationEmail supporting documents to Marketing@FNBAlaska.com, with the subject line “Supporting documents for (your nonprofit’s name) donation request.” NameThis field is for validation purposes and should be left unchanged.