SECC 2012 Charity Application

This application is 5 pages long. If you are not prepared to complete the entire online application right now, please return when you are ready. You may download the complete application and application instructions in PDF format to review required information.

NEW OR RE-APPLICANT: *

New

Re-Applicant

SECC CODE:

New applicants will leave this area blank

If you are applying as a member of a federation, you will not use this online form. Please submit this information directly to your federation using this spreadsheet template (click to download the spreadsheet file). Please do not alter the formatting of the spreadsheet. You will also submit your 2012 Application and attachments directly to your federation.

APPLICATION TYPE: *

Independent Charity

Federation

FEDERATION:

If you are a member of federation, list that federation here.

LEGAL NAME: *

OTHER NAME (DBA Name or Program Name):

MAILING ADDRESS: *

City: *

ST: *

ZIP CODE: *

CEO or CPO NAME: *

APPLICATION CONTACT NAME: *

CONTACT PERSON'S TITLE: *

CONTACT PERSON'S PHONE #: *

use 999-999-9999 format

Fax #:

Use 999-999-9999 format

CONTACT'S EMAIL: *

CHARITY PHONE # for SECC Materials: *

use 999-999-9999 format

WEBSITE URL: *

use www.charityurl.org format