Sponsorship Request Form

If you are seeking support from Member One, we will consider requests from 501(c)3 organizations that directly benefit the communities we support: Roanoke Valley, Franklin County, Lynchburg Area, New River Valley, and Botetourt County.

Please fill out our request form below. Our committee reviews all requests as quickly as possible, but we recommend you submit your request at least 90 days prior to your event/deadline to allow time for review.

Your Information

First Name:

Last Name:

Email:

Phone Number:

Organization Name:

Your Title or Affiliation with the Organization:

Organization's Information

This organization is a sanctioned, tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code (or similar code sections), or a sanctioned state or local governmental agency (non-profit organization). Non-sanctioned organizations will not be considered. YesNo

EIN from the organization's W-9:

This organization serves people in and is local to Member One’s service area. If not, the request will not be considered. YesNo

If the organization receives funding or a donation from Member One, how will it be used?

If Other, where does this organization serve?

What was the organization’s annual operating budget for the previous year?

Has Member One funded this organization during the current calendar year? YesNo

Number of participants/clients who directly benefit annually from this organization’s services: 0-199200-500More than 500

Please describe the primary group of clients/participants who benefit most from this organization’s services:

Does the organization provide free services to those in need? None of the services are completely freeSome of the services are free or costs are partially offsetAll of the services are free for participants/clients

Does the organization have income requirements or guidelines to serve those in need? YesNo, there are no income requirements

If Yes, please explain. (For example: Individuals with a household income of less than 200% of the federal poverty level qualify for services)

Event Sponsorship

Does this request support or sponsor a specific event? Yes - We're requesting funding for a specific fundraising eventNo - We're requesting general funding

Event Name:

Event Date:

Brief Event Description:

Approximate Event Attendance:

Minimum Dollar Amount Requested:

Cause-Based Alignment

Member One is particularly interested in supporting non-profits that improve the lives of those who are financially vulnerable in our region. To that end, we’ve identified several areas of focus for support. Please identify any way the organization aligns with or supports the categories below.

Which of the following areas of need does your organization support?

Check all that apply.

HousingHealthcareChildcareFood InstabilityEmploymentNone of these

If None of these, what are some areas your organization supports?

Housing

Approximately how many individuals does this organization work to move towards permanent housing annually?

How many individuals does this organization temporarily house annually?

How much (dollars) does this organization offset in housing and/or utilities costs for individuals annually?

Other housing benefits individuals receive:

Healthcare

How many patients benefit from cost-free services because of your organization annually?

How much (dollars) does your organization offset in healthcare costs for individuals annually?

Please describe any other healthcare cost benefits individuals receive through your organization:

Childcare

How many hours of cost-free childcare does this organization provide annually?

How many children does your organization support annually?

Other childcare benefits individuals or families receive:

Food Instability

Approximately how many meals (or equivalent) does this organization provide annually for our communities?

How much (dollars) does your organization spend annually on direct food purchases for those in need?

Please describe any other efforts to reduce food instability in our area:

Employment

How many participants attend education or job-training programs through your organization annually?

How many hours of cost-free education or job training does your organization offer annually?

Please describe any other employment benefits including support services individuals receive through your organization:

Financial Education

Would you be open to partnering with Member One in offering the organization’s participants or staff basic financial education seminars? YesPossiblyNo

Would you be open to offering your participants free one-on-one financial counseling through Member One? YesPossiblyNo

Volunteering

Might we serve your organization through corporate volunteering in some way? YesPossiblyNo

Additional Information

Please enter any additional information you’d like us to consider for this request:

Uploads

Upload completed W-9 here:

Must be either a PDF or Word file

Upload project/event/or fundraising materials here:

Upload any additional information or documents here:

Please do not include any URLs in this form as your submission will not be received.

External Site

Sponsorship Request Form

Sponsorship Request Form