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Off Budget Program Funding Application - (1 of 4) Charlottesville Conditions of Eligibility Report Form To submit a funding application, an organization must meet these criteria/answer these questions: ORGANIZATION NAME : 1. Is the organization organized, qualified, and recognized as n onprofit and tax -exempt as defined by the Internal Revenue Service under 26 U.S.C. 501(c)(3)? Yes No If yes, please provide a copy of your IRS status letter 2. Does the organization provide services that directly benefit human beings? Yes No 3. Does the organization have a direct and substantial presence in the City of Charlottesville? Yes No 4. Is the organization incorporated as defined by the State Corporation Commission? Yes No Date of agency incorporation: ** Please include a copy of Articles of Incorporation 5. Is the organization registered completely with the Virginia Department of Agricult ure and Consumer Services, Division of Consumer Affairs, Charitable Solicitation Section? Yes No 6. Is the organization directed by a volunteer Board of Directors that meets at least quarterly? Yes No 7. a. If the organization’s annual budget is over $200,000, is the organization audited by an independent certified public accountant each year? Yes No b. If the organization’s annual budget is under $200,000, is the organization audited by an independent certified public accountant at least every three years? Yes No 8. Did this organization request funding for this specific program during the budget cycle? Yes No ___________________________________ ____________ Signature of Chief Professional Officer Date