Provider of Assistance to Impoverished (Non-Profit)

1. Services to impoverished persons (as defined in section 673 of the Community Services Block Grant Act) (42 U.S.C. 9902) must be the primary function of the organization. If any activity operates a broad spectrum of programs through which assistance to the impoverished is peripheral and incidental, the entity would not be eligible. If located in or around a religious facility, food banks must have a direct entrance not requiring entrance through a place of worship to be eligible.

2. Required additional documentation that must be submitted with application:

a. Letter from IRS certifying as a 501(C) non-profit. IRS ruling letter must include current name and address.

b. Latest Annual Financial Statement

c. Public Recognition as an Impoverished Assistance Provider. Submit at least one of the following:

i. Provide letter of endorsement from an official (i.e. Mayor, Head of Welfare Dept., Social Services Director, county supervisor, head of agency that oversees program, etc.) indicating services provided by applicant. The letter must indicate that assistance to the impoverished is the organization’s primary focus, and the name must match the IRS document.

ii. You may also include documented receipt of Federal/State Block Grant Funds for poverty programs, or

iii. Proof of membership or affiliation with national organization that provides support for impoverished (i.e. Second Harvest National Food Bank Network, Habitat for Humanity, Salvation Army).

d. Complete narrative about your organization, including:

i. Comprehensive description of services (assistance to impoverished must be primary mission);

ii. Number of individuals receiving assistance and frequency of assistance (daily, weekly or monthly);

iii. Requirements for clients to be eligible to receive services, including any required fees;

iv. Description of facilities;

v. Hours/days of operation;

vi. Description of funding source(s) with supporting documentation; and

vii. Overview of staff (paid/volunteer, full-time/part-time) including list of key staff and their qualifications.

e. Description of how your organization determines if a person is eligible to receive assistance, and how your organization determines if that person is impoverished. Your organization’s primary function must be to provide money, goods, or services to families or individuals whose annual incomes are below the poverty line (as defined in section 673 of the Community Services Block Grant Act) (42 U.S.C. 9902). If recipients are required to complete an application before receiving services, please attach a sample application.

f. Proof of current accreditation, approval or licensing if appropriate (i.e. child care or medical/health center).

g. Signed Articles of Incorporation, Bylaws, Charter or other organizing document

h. Brochures (or other printed materials) or link to website (Optional)