Roseville Fun Jump Contribution Request

All Contribution Requests must be submitted at least 90 days in advance.

Roseville Fun Jump will review and consider qualified requests and supplementary information and will respond to the requesting organization within 45 days of submission.

ORGANIZATION INFORMATION

Organization Name:
Address:		City:		State:		Zip Code:

Contact Name:		Telephone:
Email:		Fax:

SERVICE DELIVERY

Summarize the organization's mission:

Identify association with Roseville Fun Jump's employee, if any:

Financial Information

What is the organization's current annual operating budget:
For the organization's current operating budget, what amount is derived from:
	1. Earned Income:
	2. Individual Contributions:
	3. Corporate Donations:
	4. government Grants:
	5. Foundation-Endowment Contributions:
	6. United Way:
	7. Other (please specify):
What percentage of the operating budget is for administration:
What percentage of the operating budget is for fundraising:

DONATION SUMMARY

Describe the program for which a donation is currently sought:

What is the total goal of the fundraising activity:

Describe the specific donation request of Roseville Fun Jump:

Briefly describe the measurable objectives and timetable for program activities:

What target population is to be served:

How will you notify the target population of the event:

PROGRAM ASSESSMENT

Describe how the program's success will be defined:

What is the timetable for evaluating and reporting the programs's results: