Planters Bank Community Impact Donation Submission

Planters Bank Community Impact Donation Submission

We truly appreciate your organization for providing services and essential support to help our local communities thrive.

Please read this document carefully and review the Planters Bank Donation program requirements before completing this application.

By accepting a Planters Bank donation, your organization accepts and agree that Planters Bank can share information including photos regarding the donation, donation amount, what it is expected to be used for and this information can be shared through internal and external communications; i.e., on social media, with media organizations, and any other interested parties, etc.

Organization's Name*

Submission Date*

Amount Requested

Please provide the use of donation funds*

Please describe how the donation funds will help support the people that your organization serves. Also provide a brief mission statement and purpose of your organization. This will be used by the Planters Bank Community Impact Donation Committee to evaluate your application.

Website:

Business Address (Physical location of business)*

City*

State*

Zip code*

Federal Tax Identification Number*

IRS-Recognized Nonprofit*

Select

Cities or Counties Served?**

Contact Name*

Telephone Number*

Email*

Does this request address PB Community Needs?*

Planters Bank Community Impact Donation Program focuses on funding programs that provides resources to our underserved/low-to-moderate income individuals, families and children; Non-profit organizations that supports the economic development for small businesses and small farms. Services that promote the health, financial well-being, affordable housing, revitalization and improvements to our local communities.

Examples: Healthcare clinics and other initiatives designed to provide services to those with limited access. • Community services that assist families in crisis. • Educational Services - Planters Bank can partner with Non-profits and schools to provide direct financial literacy workshops, banking and career mentorship support to schools and community-based nonprofit organizations that enhance the educational development of local children. Examples include: Organizations that provides children with constructive learning and mentorship opportunities; After-school programs that provides financial literacy workshops and financial management tools.

Select

Describe Program or Project

Does your program provide services to LMI people?*

Underserved or low-to-moderate income individuals and/or families?

Select

Provide the Percentage of LMI People served

Provide # of LMI people served in the past 2 years

Received a Planters Bank donation?*

Select

If yes, please list the dates and amounts

Enter in this format: MM/DD/YYYY - $1000.00 MM/DD/YYYY - $1000.00 MM/DD/YYYY - $1000.00

Does the organization have a Planters Bank Account*

You are not required to have a Planters Bank account to apply or qualify for a donation.

Select

Volunteer Opportunities?

Select

If yes, please describe how we can help.

CRA Qualified*

Non-profit organizations that primarily serves underserved/LMI people in community services, affordable housing, economic development or revitalization/stabilization.

Select

File Upload

Required Documents: • Tax Exempt Status Letter: Copy of your organization’s IRS 501(c)(3) tax-exempt status letter. • W-9 - Request for Taxpayer Identification Number and Certification https://www.irs.gov/pub/irs-pdf/fw9.pdf The following documents would be helpful, but are not absolutely required: • Grant Request/Proposal Letter • Project/program budget detailing expenses, anticipated income sources, and any previous funding by Planters Bank. • Current list of businesses and foundation donors with their contribution level that supports your organization. • Current list of donors to the proposed project with their contribution levels. • Current annual operating budget with income and expenses. • List of your organization’s Board of Directors, including names, titles, and affiliations. • Information on volunteer opportunities. Schools or units of government: Submit your request on official letterhead. Provide list of schools served (if applicable)

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