New Orleans City Council

New Orleans City Council-Cox Communications Louisiana's Community Grant Program Application

* required field

Questionnaire

Are you a 501(c)(3) non-profit? *
Is your organization or project located in Orleans Parish? *
Are you authorized to do business/operate in the State of Louisiana? *
Does your organization have a Board of Directors and/or Officers? *
Is your organization or project politically related? *
Applicant agrees to acknowledge Cox and the Council in promotional materials and media appearances associated with the program. *

Applicant Contact Information

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Organization Information

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Program/Project Information

Did you receive Cox Grant funds in the previous calendar year? *
Funding under this program shall be limited to not more than 50% of the organization’s total annual budget or 25% of the annual budget of an organization that is less than a year old (see “budget” definition under “Eligibility,” below). Subject to your sworn certification attached hereto, do you meet these criteria? *
Council District(s) requesting funds from *
(More than one can be selected)
Now
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Required Documentation

  • Copy of the IRS 501(c)(3) determination letter indicating tax exempt status or that of the Fiscal Agent
  • Completed W-9 Form for the current year
  • Copy of the Articles of Incorporation
  • Proof of Good Standing from the Louisiana Secretary of State’s Office (a print-out of the Secretary of State’s page will suffice)
  • List of the Board of Directors and Officers, including position within the organization as well as professional occupation and title, if applicable
  • Letters and permits showing necessary City/Parish approval of project, if applicable
  • Copy of the organization’s operating budget for the current fiscal year
  • Budget for the project or program that is the subject to this application, showing how grant funding will be used
Max file size is 50MB!. Please zip all documentation into a single ZIP file.

Certification

Agreement *

By making and signing this application, I agree to be bound by and adhere to all state, municipal and federal laws and regulations that are applicable to me and/or my company, and those that apply to Cox Communications Louisiana, LLC as they relate to funding of this proposed grant.

I further represent and warrant that none of the funds received pursuant to this grant, should it be awarded to me or my organization, will be used except in accordance with the information contained in this application, nor will any of the funds awarded be shared with any third-party entity except in payment for the fair market value of actual goods provided or services rendered in connection with carrying out the proposal authorized in this application. I agree to allow the City of New Orleans reasonable access to my books and records for compliance review and audit. The New Orleans Inspector General shall also have the right to review and audit all books and records related to an application or awarded grant.

I further affirm that all of the information contained in this application is true and accurate and that I will notify the City Council in writing of any change in this information within 72 hours of any such change becoming effective. Failure to make such notifications may result in termination of the grant and potential refund of all funds received.

I understand that the breach of any of the representations or warranties or other obligations contained in this certification will result in the termination of the grant, if awarded, and that I, or my organization/business may be required to return all of the grant funds, whether or not they have been expended by me or my organization/business, and that I, or my organization/business may be disqualified from future participation in any Cox Communications Louisiana program.

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