CBE CARES APPLICATION CBE Cares Organization / Agency Name * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Executive Director * Website * Contact Person and Title * Phone * Fax Email * Type of Need General Operations Support New Program/Project Ongoing Support Capital Equipment / Materials Other Organization Tax Exempt Status * Yes No Please specify if your organization is a tax-exempt, non-profit entity (classified by the IRS as 501(c)(3): (Please provide with your application a copy of your 501(c) 3 tax status) Please specify how long your organization has existed: * Note: If your organization was recently formed (less than 2 years) we will require a copy of a W-9 as part of the review process. Please specify which category you would classify your organization: * Arts & Culture (theater, music, painting, sculpture, dance, local museums, libraries, etc.) Education (public or private institution of learning) Health (institution dedicated to healing and wholeness of life through improvement of health care, prevention of substance abuse, etc. Human Services (assisting youth, women, minorities, the elderly, economically or physically disadvantaged people, families in need, etc.) Describe the mission and objectives of your organization Please limit to 300 words or less. Briefly describe how your organization contributes to the development/improvement of our local area. Please limit to 300 words or less. Tell us about any major achievements in the past two years. Please limit to 300 words or less. Use of Funds Describe how the donated funds would be utilized (specific program/project, etc.), how much of the donation will remain local and the desired impact on the Community. (Please limit to 300 words or less.) Three Minute Introduction If you had only three minutes to inform each of our participating employees about your organization, the project they would be funding, and the why behind it, what would you want them to know? (Please limit to 450 words or less.) For Iowa Applicants only CBE Cares comes with volunteer support for our quarterly recipient during the month they receive their donation; what projects, events, or supports could your organization use help with? In other words, how can we help you? Submit If you are human, leave this field blank.
