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Please attach a recent photo.
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Are you a US Citizen?
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Give dates and details of any projected travel to the USA for the entire year.
List all countries of citizenship
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List all countries of citizenship for your spouse
Budget Information
We understand that all categories might not apply to you and your ministry.
We understand that the amounts you project may be different from the actual amounts throughout the year.
We understand that you may or may not receive some support through other means.
Housing Expense $, (for example Housing, Travel/Special Lodging)
Office Expenses $, (for example Printer Ink, Stationary)
Transportation Expenses $, (for example Flight, Rental Car, Fuel)
Shipping and Postage $, (for example Postal Carrier Fees)
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Exhibit Information
PERSONAL MINISTRY DESCRIPTION Please describe your ministry
MINISTRY PURPOSE To the best of your knowledge what is the purpose of the ministry
METHODS OF FUND RAISING FROM US DONORS Please explain how you will raise funds from US donors for the ministry work
INTENDED RESULTS Please explain the intended results for the ministry work
METHOD FOR MEASURING RESULTS Please explain how you will measure the results for completion of the ministry work
Recital Information
Recitals
Mission Enablers International, known as Sponsor has an Internal Revenue Service (“IRS”) determination letter of qualification under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended (the “Code”) and is classified as a public charity under Code Sections 509(a)(1) and 170(b)(1)(A)(vi). Sponsor’s purposes include PROCESSING OF ALL USA DONORS’ DONATIONS AND INTERNATIONAL AFFILIATE DONATIONS TO FUNDS IN THE USA, SPECIAL OTHER CONTRIBUTIONS OF PROPERTY OR ASSETS ABLE TO BE PROCESSED BY THE MEI OFFICE;
The Individual Applicant(s), known as Grantee was formed AND does not have an IRS determination letter of qualification under Section 501(c)(3) of the Code. The Grantee’s purposes include PRESENTING TO USA DONORS THE OPPORTUNITY TO GIVE DONATIONS OF MONETARY FUNDS, STOCKS, REAL PROPERTY OR ETC TO FULFILL THE GOALS OF THE GRANTEE MINISTRY LISTED IN EXHIBIT A.
In furtherance of its charitable purposes, the Grantee operates a program (the “Sponsored Program”) as described in the grant proposal (“Grant Proposal”) which has been approved by Sponsor’s board of directors and is attached hereto as Exhibit A;
The Grantee desires to have Sponsor act as its fiscal sponsor for the purpose of soliciting and receiving gifts, grants, contributions and other revenues (collectively, “donations”) and distributing such funds to the Grantee, subject to Sponsor’s oversight, to be used exclusively in support of the Sponsored Program;
Sponsor’s board of directors has determined that the Sponsored Program furthers Sponsor’s charitable goals and tax-exempt purposes. Sponsor’s board of directors has authorized Sponsor to enter into a fiscal sponsorship agreement with the Grantee whereby Sponsor will receive donations on its own behalf and disburse such funds to the Grantee in support of the Sponsored Program, in accordance with the terms and conditions of this Agreement.
I (We) agree with the recital
Effective Date. This agreement shall become effective onAgreement Date
FISCAL SPONSORSHIP
Sponsored Program Activities. The Grantee’s officers shall act as principal coordinators of the Sponsored Program. Sponsor retains oversight authority to ensure that the funds disbursed by Sponsor to the Grantee in support of the Sponsored Program are used for their intended charitable purposes.
Receipt and Disbursement of Funds; Variance Power. In connection with its sponsorship of the Grantee, Sponsor agrees to receive donations that are designated as made in support of the Sponsored Program (“Sponsored Program Funds”). Sponsor anticipates granting Sponsored Program Funds to the Grantee, in
furtherance of the Sponsored Program (less any administrative charge set out below). Upon request by the Grantee, Sponsor will disburse Sponsored Program Funds to the Grantee, assuming sufficient funds are
available; provided, however, that in order to receive further disbursements the Grantee must be in
compliance with all of its obligations under this Agreement, including specifically the reporting
requirements set forth in Section 5 hereto, and further provided that the date and amount of each
disbursement of Sponsored Program Funds shall be within the discretion and control of Sponsor. The Grantee assumes the risk that any funding source may exercise its discretion not to grant or not to appropriate funds to Sponsor for the support of the Sponsored Program. The parties intend that this Agreement be interpreted to provide Sponsor with variance powers necessary to enable Sponsor to treat the Sponsored Program Funds as Sponsor’s assets while this Agreement is in effect. Sponsor, in its sole discretion, shall have the right to withhold, withdraw, or demand the immediate return of any Sponsored Program Funds if, in Sponsor’s reasonable judgment, the Grantee materially breaches this Agreement or cannot accomplish the purposes of the Sponsored Program. Sponsor retains the right, in its sole discretion, to redirect the Sponsored Program Funds to a different charitable purpose or beneficiary if the purpose of the Sponsored Program becomes unnecessary, incapable of fulfillment, or inconsistent with the charitable needs of the community served by Sponsor.
Substantiation of Charitable Donations. Sponsor agrees that all Sponsored Program Funds will be reported for federal tax purposes as contributions to Sponsor and further agrees to acknowledge receipt of such Sponsored Program Funds in writing to donors, as required under federal tax law, and to furnish evidence of Sponsor’s status as an organization qualified under Section 501(c)(3) of the Code to donors on request.
Administrative Charge. Sponsor will retain an administrative charge to cover the costs associated with its management of the Sponsored Program Funds and other administrative expenses associated with this Agreement. This administrative charge shall be NO LESS THAN: 3.5 percent of the gross amount of the Sponsored Program Funds received by Sponsor QUARTERLY FEES TO BE DETERMINED.
REVIEW BY SPONSOR
Financial Reporting and Access. Sponsor and its representatives shall be given full access to the books, records, and senior management and financial personnel of the Grantee with respect to the Sponsored Program as Sponsor may reasonably request. Sponsor may, at its own expense, conduct an independent financial audit and/or program audit of the Grantee’s books and records in relation to the charitable activities for which Sponsor has disbursed Sponsored Program Funds. A QUARTERLY REPORT MUST BE SUBMITTED BY GRANTEE TO GRANTOR’S (MEI’S) OFFICE.
FINANCIAL ACCOUNTING AND REPORTING
Accurate Recording and Reporting. Sponsor and the Grantee will maintain books and financial records for the Sponsored Program in accordance with generally accepted accounting principles, shall retain records as long as required by law and shall make records available to auditors as required by law. The Grantee will reflect the activities of the Sponsored Program, to the extent required, on its state and federal tax and information returns and financial reports. All disbursements from the Sponsored Program Funds shall be made payable to the Grantee.
I (We) agree with recital
GRANTEE REPORTING REQUIREMENTS
Reports to Sponsor. The Grantee shall submit full and complete quarterly reports to Sponsor on the progress of the Sponsored Program. Such reports shall be due within thirty (30) days of the end of each calendar quarter, for so long as this Agreement remains in effect. Such reports shall describe the Grantee’s use of the Sponsored Program Funds, compliance with the terms of all grants, and the progress made by the Grantee in accomplishing the purposes of the Sponsored Program.
I (We) agree with recital
NOTICES
Address Notices. All notices or reports under this Agreement shall be addressed as follows:
Mission Enablers International PO Box 2127 Bentonville, AR 72712 Attention: Compliance Department
Grantee Address given above
*See Above
Such addresses may be changed by written notice or email notice given by such party to the other or by other form
of notice agreed to by the parties.
I (We) agree with recital
DISPOSITION OF SPONSORED PROGRAM FUNDS IN TERMINATION
Disposition of Sponsored Program Funds in Termination. If there are any Sponsored Program Funds remaining
after this Agreement has terminated, the following terms and conditions shall apply, subject to Sponsor’s
variance power set forth above at Section 2b:
If the Grantee has received a determination letter from the IRS of its qualification under Section 501(c)(3)
of the Code, Sponsor shall transfer the balance of all Sponsored Program Funds, net of any liabilities
incurred by Sponsor in connection with the Sponsored Program, to the Grantee for use in the Sponsored
Program.
If the Grantee has entered into a written fiscal sponsorship agreement with another fiscal sponsor that has
an IRS determination letter of qualification under Section 501(c)(3) of the Code, then Sponsor shall
transfer the balance of any Sponsored Program Funds, net of any liabilities that Sponsor has incurred in
connection with the Sponsored Program, to such new fiscal sponsor for use in the Sponsored Program.
In the event that the Grantee has not received an IRS determination letter from the IRS of qualification
under Section 501(c)(3) of the Code or entered into a written fiscal sponsorship agreement with another
fiscal sponsor that has an IRS determination letter of qualification under Section 501(c)(3) of the Code,
Sponsor may allocate the Sponsored Program Funds in any manner consistent with applicable tax and charitable
trust laws.
RELATIONSHIP OF THE PARTIES
Relationship of the Parties. Nothing in this Agreement shall constitute the naming of either party hereto as
an agent or legal representative of the other party for any purpose whatsoever except as specifically and to
the extent set forth herein. This Agreement shall not be deemed to create any relationship of agency,
employment, partnership, or joint venture between the parties hereto and the Grantee shall make no such
representation to anyone. It is the intention of the parties that all employees, contractors, and advisors
for the Grantee will be employed or engaged directly by the Grantee and not by Sponsor.
I (We) agree with the recital
INDEMNIFICATION
Indemnification. The Grantee hereby irrevocably and unconditionally agrees, to the fullest extent permitted
by law, to defend, indemnify, and hold harmless Sponsor, its officers, directors, trustees, employees and
agents, from and against any and all claims, liabilities, losses and expenses (including reasonable
attorneys’ fees) directly, indirectly, wholly or partially arising from or in connection with any act or
omission of the Grantee, its employees or agents, in applying for, accepting, expending or applying
Sponsored Program Funds, or in carrying out the Sponsored Program, except to the extent that such claims,
liabilities, losses or expenses arise from or in connection with any negligent act or omission of Sponsor,
its officers, directors, trustees, employees or agents.
I (We) agree with the recital
FUNDRAISING
Fundraising. The Grantee shall notify Sponsor (a) of all jurisdictions in which it would like Sponsor to solicit charitable contributions from the public in support of the Sponsored Program; and (b) if it intends to engage a commercial fundraiser to solicit charitable contributions from the public in support of the Sponsored Program. All solicitations for the Sponsored Program shall be made in Sponsor’s name. All solicitation materials that use the name of Sponsor or its affiliates, including both written solicitation materials and scripts for oral solicitation communications, shall be subject to Sponsor’s advance approval. The Grantee shall comply with all laws and regulations concerning the solicitation of charitable contributions. All original letters of inquiry and grant proposals that use the name of Sponsor or any of its affiliates shall be subject to Sponsor’s advance approval in its sole discretion and shall be signed by an authorized representative of Sponsor. All grant agreements, pledges, or other commitments with funding sources to support the Sponsored Program shall be subject to Sponsor’s advance approval in its sole discretion and shall be executed by Sponsor. The cost of any reports or other compliance measures required by such funding sources shall be borne by the Grantee.
I (We) agree with recital
PUBLICITY
Publicity. Any and all use of Sponsor’s name in media communications and fundraising materials with respect
to the Sponsored Program shall be subject to Sponsor’s prior review and approval. The Grantee shall provide
Sponsor with reasonable advance notice with respect to any proposed use of Sponsor’s name in order to allow
for such prior review.
I (We) agree with recital
DURATION OF AGREEMENT
This Agreement shall remain in effect until the earliest of the following:
Grantee receives a determination letter from the IRS of its qualification under Section 501(c)(3) of the
Code;
Sponsor or Grantee terminates this Agreement pursuant to the provisions of Termination Sections below; or
DECEMBER 31, 2024.
I (We) agree with recital
TERMINATION
Termination. Either party may terminate this Agreement without cause by giving thirty (30) days’ written
notice to the other party. Such notice must be SIGNED BY BOTH PARTIES VIA CERTIFIED SIGNATURE MAIL.
I (We) agree with recital
DISPOSITION OF SPONSORED PROGRAM FUNDS IN TERMINATION
Disposition of Sponsored Program Funds in Termination. If there are any Sponsored Program Funds remaining
after this Agreement has terminated, the following terms and conditions shall apply, subject to Sponsor’s
variance power set forth above at Section 2b:
If the Grantee has received a determination letter from the IRS of its qualification under Section 501(c)(3)
of the Code, Sponsor shall transfer the balance of all Sponsored Program Funds, net of any liabilities
incurred by Sponsor in connection with the Sponsored Program, to the Grantee for use in the Sponsored
Program.
If the Grantee has entered into a written fiscal sponsorship agreement with another fiscal sponsor that has
an IRS determination letter of qualification under Section 501(c)(3) of the Code, then Sponsor shall
transfer the balance of any Sponsored Program Funds, net of any liabilities that Sponsor has incurred in
connection with the Sponsored Program, to such new fiscal sponsor for use in the Sponsored Program.
In the event that the Grantee has not received an IRS determination letter from the IRS of qualification
under Section 501(c)(3) of the Code or entered into a written fiscal sponsorship agreement with another
fiscal sponsor that has an IRS determination letter of qualification under Section 501(c)(3) of the Code,
Sponsor may allocate the Sponsored Program Funds in any manner consistent with applicable tax and charitable
trust laws.
MISCELLANEOUS PROVISIONS
Amendments. This Agreement may not be amended or modified, except in a writing signed by both parties hereto.
Dispute Resolution. In the event of a dispute under this Agreement, Sponsor and the Grantee shall make a good faith effort to resolve such dispute cooperatively before seeking to resolve any dispute by arbitration or otherwise proceeding with any remedy available at law or in equity.
Choice of Forum. The parties agree that the Tennessee state courts are the exclusive venue for actions relating to this Agreement. The parties agree that the State of Tennessee is a convenient forum, and that all court proceedings shall be filed in Tennessee and in no other forum.
Consent to Jurisdiction. For all purposes related to this Agreement, the parties hereby consent to personal jurisdiction in the state courts in and for the state of Tennessee.
Entire Agreement. This Agreement constitutes the entire agreement of the parties with respect to the subject matter hereof; it supersedes any prior agreement and understandings between the parties as to such matters, oral or written, all of which are hereby cancelled.
Governing Law. This Agreement shall be governed by and interpreted in accordance with the laws of the state of Tennessee.
Severability. Each provision of this Agreement shall be separately enforceable, and the invalidity of one provision shall not affect the validity or enforceability of any other provision.
Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.
I (we) agree with the recital
Terms and Conditions
By checking this box I agree to the following.
By submitting this Agreement, I (we) are agreeing to the terms and conditions of this application and any Mission Enablers International requirements. I (we) understand our obligations and consent to comply with all regulatory, legal, and internal changes.
By checking this box I agree to the following.
I understand that an additional Agreement may be needed for short or long term, temporary or permanent, and/or other projects at any time.
By checking this box I agree to the following.
Under penalty of perjury, I confirm that the information submitted in this form is true and accurate to the best of my knowledge.
By checking this box I agree to the following.
By submitting this Agreement, I (we) understand that I (we) will report any and all information needed by Mission Enablers International upon request. This may include but is not limited to, fiscal updates, ministry changes, staff and personnel changes, and program changes.
By checking this box I agree to the following.
By submitting your application and authorization, you acknowledge that MEI is a Texas non-profit organization that is tax exempt under I.R.C. § 501(c)(3) and MEI exercises complete discretion and control over all funds received and reserves the right to deny services and allocate funds toward any activity consistent with its purpose.
By checking this box I agree to the following.
By submitting this Agreement, I (we) understand that this account is only for the Grantee. The Grantee will not allow others to use this account for fundraising purposes. The Grantee agrees to contact Mission Enablers International if such needs arise.
Signature (Type Your Name to Sign the Form)