MEMBERSHIP APPLICATION
Other _________
Foundations & Giving Programs
Name of organization: Click here to enter text.
Contact person and title: Click here to enter text.
Phone and email: Click here to enter text.
Second contact person and title: Click here to enter text.
Phone and email: Click here to enter text.
Address: Click here to enter text.
City: Click here to enter text. State: Click here to enter text. Zip: Click here to enter text.
Fax: Click here to enter text.
The Connecticut Council
for Philanthropy is an
association of
grantmakers committed
to supporting and
promoting effective
philanthropy for the
public good.
Council membership is
open to foundations
(private, corporate,
community), business
and corporate giving
programs, federated
funds, bank trusts,
donor-advised funds,
individual
philanthropists and
those serving the
philanthropic sector.
Website: Click here to enter text.
Type of Grantmaker:
☐ Corporate Giving Program
☐ Community Foundation
☐ Independent Foundation
☐ Other
☐ Corporate Foundation
☐ Family Foundation
☐ Public Foundation
Year Founded: Click here to enter text. Number of Paid Staff: Click here to enter text. Full-Time: Click
here to enter text. Part-time: Click here to enter text.
Please write a brief statement about your organization’s funding areas.
Click here to enter text.
Please check any of the areas in which you fund:
☐ Aging
☐ Arts, Culture & Humanities
☐ Children & Youth Services
☐ Civil Rights, Social Action
☐ Community Improvement &
Capacity Building
☐ Crime/ Courts/Legal Services
☐ Diseases, Disorders & Medical
Disciplines
☐ Early Childhood
☐ Economic Development
☐ Education
☐ Employment/Jobs
☐ Environment & Animals
☐ Equity and Inclusion
☐ Food, Agriculture & Nutrition
☐ Health
☐ Higher Education
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Housing & Shelter
Human Services
Medical Research
Mental Health & Crisis Intervention
Out-of-School/After School
Philanthropy, Voluntarism & Granting
Public Affairs & Societal Benefit
Public Safety, Disaster Prep & Relief
Recreation/Sports/Leisure
Science & Technology
Social Sciences
Special Education
Women & Girls
Workforce
Youth Development
Youth Violence Prevention
Not Classified/Unknown
Briefly describe those areas that you do not fund.
Click here to enter text.
Please give a brief statement about the geographic areas that your organization funds.
Click here to enter text.
Financial Data
Please provide the following data for the most recently completed fiscal year.
To apply for
membership, please
submit:
Fiscal year: Click here to enter text. Total assets: Click here to enter text. Total grants: Click here to enter
text. Total CT grants: Click here to enter text.
Range (smallest/largest): Click here to enter text. Average grant size: Click here to enter text.
Frequency of board meetings: Click here to enter text. Application deadlines: Click here to enter
text.
Accept the Council’s common grant application:
Accept the Council’s common report form:
Accept unsolicited requests:
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
Please check those resources your organization makes available to potential grantees:
☐ Annual report
☐ Application form ☐ Grants list ☐ Guidelines ☐ Newsletter ☐ Other
Please check which types of support you give:
☐ Capital campaigns
☐ Emergency funds
☐General purpose/operating
☐ Program-related investments ☐ Project support ☐ Technical assistance ☐ Student aid (to
institutions)
☐ Other
If you represent a corporate foundation or giving program:
Does your organization have a matching gifts program? ☐ Yes ☐ No
Does your organization have a grants program to support organizations where employees
volunteer? ☐ Yes ☐ No
SUPPORT SCHEDULE
MEMBERSHIP SUPPORT SCHEDULE
Membership support is on a sliding scale,
determined according to each member's
total giving in Connecticut as averaged
over the most recent three-year period.
This annual support is based on the
calendar year.
3-Year average
Connecticut Giving
Membership
Support
Less than $25,000
$500
$25,000 to $50,000
$750
$50,000 to $100,000
$1,100
$100,000 to $200,000
$1,450
$200,000 to $300,000
$1,800
$300,000 to $400,000
$2,150
$400,000 to $500,000
$2,500
$500,000 to $600,000
$2,900
$600,000 to $700,000
$3,200
$700,000 to $800,000
$3,600
To figure 2014 support:
$800,000 to $900,000
$3,950
$900,000 to $1-million
$4,300
Step 1: Add
CT total grants FY 2013 $ Click here to enter
$1-million to $2-million
$5,000
$2-million to $3-million
$5,800
$3-million to $4-million
$6,500
CT total grants FY 2012 $ Click here to enter
$4-million to $5-million
$7,200
> $5-million
14% (.00144)
of 3-year
average
text.
($24,000 maximum
Use the support schedule to determine your
support level according to your yearly
average. For new members, support is prorated from the time of membership
acceptance.
text.
CT total grants FY 2011 $ Click here to enter
text.
Total: 3-years above: $ Click here to enter
3-year total by 3 to obtain yearly average: $
Click here to enter text.
Enter Membership Support Here:
$ Click here to enter text.
For other ways to support the Council, you
may consider contributing to the Leadership
Fund or providing a Sponsorship. Please
contact the Council at 860-525-5585 for
more information.
Contribution to Leadership Fund: $ Click here
to enter text.
Total Amount Enclosed Here: $ Click here to
enter text.
☐ A check made out to the Connecticut
Council for Philanthropy in the amount of $
Click here to enter text. is enclosed.
☐ Please charge credit card $ Click here to
enter text.
☐ Visa
☐ MasterCard
☐ Amex ☐ Disc
text.
Card Number: Click here to enter text.
Step 2: Divide
Expiration Date: Click here to enter text.
Signature: Click here to enter text.
Name on Card: Click here to
enter text.
Date: Click here to enter text.