Charity Application Pick Your Charity's Category(Required) Independent Charity Federation Is this the first time your organization has applied to the SECC?:(Required)YesNoWhat is your SECC Code?If you do not know your code, please leave blankLegal Name of Organization:(Required) Other Name [DBA or Program Name]:This name must be a legal name or a registered DBA Name of CEO/President/Executive Director:(Required) Name of Agency Contact:(Required) Contact's Phone Number:(Required)Agency Contact's Email Address(Required) Additional Contact's Email AddressInclude an additional contact if you would like another person to receive information related to the campaign, such as disbursement information or donor acknowledgement info. Phone Number(Required)WebsiteEnter the organization's web address, including http:// or https://. This will be the website address that accompanies your listing in the online search tool. Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Federal Tax ID:(Required) Location of Services (Please choose all that apply)(Required) Statewide National International Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Gates Graham Granville Greene Guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln Macon Madison Martin McDowell Mecklenburg Mitchell Montgomery Moore Nash New Hanover Northampton Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland Stanly Stokes Surry Swain Transylvania Tyrrell Union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin Yancey Service/Impact Areas (Please choose all that apply)(Required) Aging/Senior Services Animal/Wildlife Services & Protection Arts & Culture Children & Youth Development Civil/Human Rights & Social Justice Community Development/Impact Disabilities & Special Needs Services Disaster Readiness/Relief & Public Safety Domestic Violence & Child Abuse/Neglect Economic/Employment & Financial Services Education & Learning Resources Environment - Conservation & Sustainability Faith-Based Services Family Planning First Responders/Emergency Assistance Food Assistance & Agriculture/Nutrition Education Foundations - Educational Hospice & Palliative Care Housing Resources/Assistance Humanitarian Aid & Relief Medical - Children Medical - Healthcare Resources Medical - Disease Research Mental Health & Crisis Intervention Military/Veterans Services Recreation & Sports 25 Word Description:(Required)Describe the organization’s programs and services and how those services stand out from other agencies that provide similar services in 25 words or less. This description cannot exceed 25 words and will be what appears with each charity’s listing in the online search tool. FRA %(Required)Source for FRA %(Required) Audit 990 Upload AuditIf you used an audit as the source for your FRA % you must upload the audit document used for that calculation.Max. file size: 128 MB.How do you want to submit your Member Information?(Required)Please choose 1 of 2 options to submit any necessary Member attachments. Either uploading directly via this form as a .zip or .rar compressed folder or sharing a link to a cloud based file folder (such as google drive, dropbox, etc.) where we can access all required documents. Share a Link Upload a .zip or .rar file Upload Federation Member SpreadsheetUpload the spreadsheet with your full list of eligible MembersAccepted file types: xls, xlsx, xlsm, Max. file size: 128 MB.Federation: New Member AttachmentsAny member of a Federation participating for the current year that did not participate in last year's campaign must have all their attachments submitted by the Federation. (If your file is large than 128mb, please create two files and upload here together.) Drop files here or Select files Accepted file types: zip, rar, Max. file size: 128 MB. Federation: New Member Attachments LinkPlease enter a link to a cloud based file folder that contains your member attachments. If a password is required, please enter the link address followed by a comma and then the password. Upload your Excessive FRA% ExplanationPlease provide a statement from your organization explaining why your FRA % exceeded 25%.Max. file size: 128 MB.Upload Campaign Application Certifications(Required)Please complete the certifications document including the signature of an authorized agent of the charity then upload.Max. file size: 128 MB.Upload Request for Inclusion Letter(Required)Upload a letter from your Board of Directors requesting inclusion in the State Employees Combined Campaign for 2022. It must certify compliance with the SECC eligibility standards, be signed by a VOTING MEMBER of the board and dated, and be on organizational letterhead of the charity.Max. file size: 128 MB.Upload 990(Required)Upload a copy of your 990 that covers 2019 or a more recent year. File must include first 12 pages of the 990 with the complete signature (digital signatures are acceptable).Max. file size: 128 MB.Upload NC Solicitation License(Required)Upload a CURRENT NC Solication License. MUST BE VALID ON OR AFTER MARCH 15th, 2022 (extensions allowed). The license must list any DBA being used for the SECC ***If you do not have a current Solicitation License, you can upload a document showing an extension. If you are waiting on approval from the State, please upload a document that shows the online status of your license.***Max. file size: 128 MB.Submitted By(Required)Please provide the email address for the person submitting this application Would you like to provide a direct link to volunteer opportunities with your charity(Required)If you have NC based volunteer opportunities that you would like listed on the NCSECC website and made available to State employees, please click yes and provide the link below. Links will be featured on our volunteer page for all charities whose applications are approved to participate in the campaign Yes No Volunteer Website AddressPlease provide a link that connects directly to volunteer opportunities with your charity and not a generic link or homepage. PhoneThis field is for validation purposes and should be left unchanged.