Epson's Focused Giving Community Relations Application

Organization Name *

Organization Website

Applicant First Name *

Applicant Last Name *

Contact Phone Number *

Applicant Email *

Applicant Mailing Address *

Alternative Contact First Name *

Alternative Contact Last Name *

Alternative Contact Phone Number *

Alternative Contact Email *

Organization Location / City and State *

Organization's Purpose *

What type of support are you applying for? *

Product type

Media ex: paper, ink, transfer film, etc
Inkjet printers
Scanners
Pro Photo imaging printers
Pro Imaging printers
Business projectors
Home Theater projectors

Requested funds

Please list the quantity and name of products you are requesting. If you do not know a specific product name, please describe what you are requesting.

Were you referred to this program by an Epson employee?

No
Yes

Who referred you to this program?

What area does your organization serve? *

If other, please fill in text box stating which area is served

Upload a one-sheet for your organization (PDF) *

This may include: description, charter, or mission statement.

Upload a copy of a current Statement of Activities (PDF) *

Upload a copy of current Statement of Activities (PDF). A Statement of Activities is one of the main financial statements your organization produces for financial tracking.

Upload your 501c3 tax-exempt status or T3010 document (PDF) *

Upload a completed W-9 for your organization (PDF) *

List of Board members including notation of either salary or volunteer status *

Target population including size and demographics *

Explanation of how your constituency will benefit from the donation *

Organizations that have previously received a donation from Epson must also include a statement of how the donation was used by the organization and its impact on the communities it served.

Epson's Focused Giving Program Application