Laserfiche WebLink
<br />City of Roseville <br /> Non-profit Application for use of ARPA Funds <br /> <br /> <br />Please confirm the following statements: <br /> <br />Your organization is a registered non-profit in the state of Minnesota <br /> <br />Your organization serves Roseville community members <br /> <br />Your organization provides community-based services and programs that benefit the greater good of the <br />community and not just members of your organization <br />Your organization experienced negative financial impacts that can be demonstrated with documentation <br />detailing the negative impacts OR your organization provides direct services, education, or advocacy to <br />residents of Roseville in response to the COVID-19 pandemic <br />Your organization does not advocate for a political or religious affiliation or cause <br /> <br /> <br />SUPPORTING DOCUMENTATION <br />• IRS Form 990 from most recent tax filing <br />• Current year budget for organization <br /> <br />APPLICANT SIGNATURE <br />By signing below, the applicant represents, warrants, and certifies that the information provided herein <br />is true, correct, and complete. I also certify that I have the authority on behalf of the organization to <br />submit this application and legally bind the organization. <br /> <br /> <br /> <br />___________________________________________ _March 9, 2023___ <br />Authorized Signer Date <br /> <br />Print Name <br /> <br />Organization Name <br />✔ <br />✔ <br />✔ <br />✔ <br />✔ <br />Mary McKeown <br />Keystone Community Services <br />Attachment D