POLICY 5. CIVIC APPROPRIATION

November 7, 2005

   CIVIC APPROPRIATION - APPLICATION REQUIREMENTS

PURPOSE         To fund projects or programs of non-profit civic organizations, which primarily benefit residents of the Town of Middletown.

ELIGIBLE
ORGANIZATION      Only 501(c)(3) tax-exempt organizations are eligible for funding. To be eligible, organizations or projects must primarily serve the residents of the Town of Middletown, Aquidneck Island, or Newport County.

APPLICATION      Each request for funding must be submitted on the Middletown Civic Appropriation Funding Request Form, and shall be accompanied by proof of agency’s 501(c)(3) tax-exempt status and agency’s budget from the prior three years. Organizations that do not have a 501(c)(3) status must provide documentation that identifies the status they operate under.

            Applications must be signed by an authorized officer of the organization and received by the Finance Director no later than the second Friday in March of each year.

            Requests for funding will not be considered unless a complete application has been submitted in accordance with these requirements.

INELIGIBLE
ACTIVITIES         The following activities will not be funded with civic appropriations:

               1.   Programs or services that serve primarily non-Middletown residents

               2.   Political activities

               3.   Marketing and/or fundraising

AGREEMENT
& REPORTING      All recipients of civic appropriations, prior to receiving funds, shall enter into an agreement with the town regarding the use of said funds. The agreement shall require that a project status report(s) be provided to the Town Council at specified intervals.

   CIVIC APPROPRIATION
   REQUEST FOR FUNDING

CONTACT INFORMATION

Agency/Organization:                                                              Application Date:                                    

Project Title:                                                                                                                                         

Total Project Cost: $                                                    Town Funds Requested: $                                       

Contact person:   Name                                           Phone Number                                               

            Fax                                              E-mail                                                          

Mailing Address:                                                                                                                                   

Project Address (if different):                                                                                                                 

AGENCY INFORMATION

Agency Purpose/Mission:

List agency officers and/or directors:

Year incorporated as a 501c(3)                                 Taxpayer ID Number (TIN)                                    

Main source(s) of funding:                                                                                                                     

PROJECT DESCRIPTION (Attach additional sheets if necessary):

ADDITIONAL INFORMATION (Please attach)

   1)   Proof of agency 501(c)(3) status, or other

   2)   Agency’s budget, prior three (3)years

   3)   Prior Middletown civic appropriations requests: list year, amount requested, amount received, and purpose of request.

   Applications and supporting information, and any questions regarding the application process should be directed to Finance Director, Middletown Town Hall, 350 East Main Rd., Middletown, RI 02842 - Phone: [phone] Fax: [phone].

      Authorized Signature                         Date