Donation Request Form - Town of Atoka, Tennessee
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General Policy
The Town of Atoka is committed to positively impacting the community by providing financial
assistance to local schools, churches, organizations and charities. Under Tennessee State Law,
the Town may allocate funding to non-profit charitable or non-profit civic organizations that, in
the Town's opinion, provide services that benefit the Town and its residents.
The following Donations Request Policy has been developed as a way to create consistency and
fairness to organizations that ask for the Town's financial support. Please be aware that the
Town attempts to fulfill as many requests as possible and cannot guarantee that every donation
request will be met. Funds for donation are approved each year during the annual budget process
and then allocated by a resolution of the Board of Mayor and Aldermen during the fiscal year.
Area of Focus
The Town of Atoka places priority on giving to qualified 501(C)3 charitable organizations and
non-profit institutions whose primary service area is or includes the municipality. Priority is
given to charitable organizations who have received support in the past and who remain in good
standing with the Town.
Exclusions
The Town of Atoka is unable to honor requests or make contributions to the following:
Donations to labor, social or political groups.
Donations to benefit specific individuals or families.
Donations of goods or services intended for online auctions.
Donations of goods or services intended for resale.
Application
Donation requests exceeding $250 must be submitted on the Town of Atoka's "Donation
Request Form" by May 1 of each calendar year.
Donation requests for less than $250 must be submitted on the Town of Atoka's
"Donation Request Form" and are accepted on an ongoing basis.
In an effort to fulfill as many requests as possible, the Town will only honor one (1)
request per organization in a fiscal year.
Incomplete applications will not be processed. The areas in red MUST be filled out
completely for us to process your request.
Policy – Donation Policy
Adopted – 03/06/12
D
P
& P
ONATION
OLICY
ROCEDURES
General Policy
The Town of Atoka is committed to positively impacting the community by providing financial
assistance to local schools, churches, organizations and charities. Under Tennessee State Law,
the Town may allocate funding to non-profit charitable or non-profit civic organizations that, in
the Town's opinion, provide services that benefit the Town and its residents.
The following Donations Request Policy has been developed as a way to create consistency and
fairness to organizations that ask for the Town's financial support. Please be aware that the
Town attempts to fulfill as many requests as possible and cannot guarantee that every donation
request will be met. Funds for donation are approved each year during the annual budget process
and then allocated by a resolution of the Board of Mayor and Aldermen during the fiscal year.
Area of Focus
The Town of Atoka places priority on giving to qualified 501(C)3 charitable organizations and
non-profit institutions whose primary service area is or includes the municipality. Priority is
given to charitable organizations who have received support in the past and who remain in good
standing with the Town.
Exclusions
The Town of Atoka is unable to honor requests or make contributions to the following:
Donations to labor, social or political groups.
Donations to benefit specific individuals or families.
Donations of goods or services intended for online auctions.
Donations of goods or services intended for resale.
Application
Donation requests exceeding $250 must be submitted on the Town of Atoka's "Donation
Request Form" by May 1 of each calendar year.
Donation requests for less than $250 must be submitted on the Town of Atoka's
"Donation Request Form" and are accepted on an ongoing basis.
In an effort to fulfill as many requests as possible, the Town will only honor one (1)
request per organization in a fiscal year.
Incomplete applications will not be processed. The areas in red MUST be filled out
completely for us to process your request.
Policy – Donation Policy
Adopted – 03/06/12
Processing
Please allow a minimum of three weeks to process your donation request.
Declined Requests: The requesting organization will receive notification via e-mail
indicating the request has been declined and the reason for the decision.
Approved Requests: The approved donation will be mailed to the organizations mailing
address provided on the Donation Request Form.
All donation decisions made by the Town are final and will be mailed according to the
date of the event and/or date donation is needed.
Requirements for Approved Requests
Organizations receiving funding from the Town of Atoka shall comply with all requirements of
Section 6-54-111 of the Tennessee Code Annotated and Title 4, Chapter 3, Section 1 of the
Internal Controls and Compliance Manual for Tennessee Municipalities.
The organization will be required to submit an annual report of its business affairs and
transactions and the proposed use of the municipal assistance.
Acknowledgement
Please acknowledge that you have read and understand the Donations Policies and
Procedures outlined above, and that your organization meets our requirements as stated,
by entering your name below:
Name of Organization: _______________________________________________
Requestor’s Name: _____________________
Signature : ______________________
Date: _____ / _____ / 20 _____
Policy – Donation Policy
Adopted – 03/06/12
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Instructions: Please read our Policy and Procedure document before completing this Donation
Request Form. The areas in red MUST be filled out completely for us to process your request.
About the Organization
Name of Organization
Federal Tax ID #
Mailing Address
Phone
City / State / ZIP
Email
Contact Person
Have you previously requested a donation
If yes, when ?
from the Town ?
If yes, was it approved ? Yes
No
Yes
No
Organization's mission statement
About the Program
Is this request for a one-time event of an
If a one-time event, what is the event date ?
ongoing program ?
One time
Ongoing
Description of event or program associated with the requested donation
About the Request
Requested donation amount
Number of people served by event/program
