Charity Funding Request Form
Thank you for your interest in garnering community support from LoyaltyOne. In order to fully review your
request, you will need to complete the form below and e-mail the completed copy, with attachments if
applicable, to [email protected].
Important: Before completing this form, please review the Appendix on page 5 to see LoyaltyOne's Funding
Request Parameters.
ORGANIZATION INFORMATION
Organization name:
CRA Charitable Tax Number:
Choose your type of business entity.
Business entity type: Not-for-Profit, Foundation, etc.
Please outline your charitable mission statement, purpose
and goals.
Main Contact for this proposal:
Address:
Telephone number:
Website URL:
How long has the organization been in operation?
Describe your governance structure and decision making
process:
Number of employees at the organization:
Number of volunteers at the organization:
What provinces/cities do you currently have operations in?
Social media Info:
Facebook page, Twitter handle, etc.
Does your organization currently issue electronic tax
receipts for donations?
Select end of fiscal year.
Fiscal year-end: December 31
Do you produce an annual, audited financial report? If so,
please provide a copy of the latest report.
Do you produce an annual social impact report? If so,
please provide a copy of the latest report.
Does your organization have any political relationships,
support, endorse or promote political, religious or faithbased activities within Canada? If so, please outline.
What % of donations, gifts and contributions received go to
organizational administration costs?
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PROJECT DESCRIPTION
LoyaltyOne’s community focus area is Youth Empowerment. This theme is supported by four strategic pillars:
Basic Needs; Education; Employment and Developing Leaders. When responding to the questions below,
please outline which focus area(s) a donation from LoyaltyOne would support.
Provide a description of the project you are requesting funding for.
How much funding are you requesting? (provide dollar amount in Canadian Dollars and or number of Air Miles)
Is this a Multi-year request? If so, please provide the number of years and breakdown of funding requested by year. We consider
proposals up to 3 years.
Provide a detailed description of how you will be evaluating the progress and success of this project. What does success in this project
look like?
POPULATION SERVED BY PROJECT
Please provide a breakdown of the
populations that will be benefit from this
donation.
YOUTH
Yes ☐ No ☐
ABORIGINALS
Yes ☐ No ☐
FAMILY
Yes ☐ No ☐
MEN
Yes ☐ No ☐
SENIORS
Yes ☐ No ☐
VETERANS
Yes ☐ No ☐
NUMBERS
COMMENTS (describe how these populations will benefit)
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VISIBLE MINORITIES
Yes ☐ No ☐
WOMEN
Yes ☐ No ☐
CANCER PATIENTS
Yes ☐ No ☐
MENTAL HEALTH
PATIENTS
Yes ☐ No ☐
PHYSICALLY
DISABLED
Yes ☐ No ☐
PHYSICAL ILLNESS
Yes ☐ No ☐
DISASTER VICTIMS
Yes ☐ No ☐
DISADVANTAGED
Yes ☐ No ☐
HOMELESS
Yes ☐ No ☐
ASSOCIATE ENGAGEMENT
Does your organization have any past or present connection with an employee of LoyaltyOne? If so, please outline. If
No, please mark NA.
Does your organization currently have any LoyaltyOne associates volunteering with the organization? (includes board
members, volunteer committees or as a general volunteer)
Does your organization offer opportunities for associates to volunteer? If so, are these ‘one-off’ or on-going volunteer
opportunities?
Does your organization offer opportunities for senior leadership development and involvement? (i.e. Board or
Committee positions)
Do you currently have capacity to create and manage an automatic payroll deduction program for our associates?
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CURRENT PARTNERSHIPS
Does your organization currently work with any of LoyaltyOne’s business partners? Please see www.loyalty.com and
www.airmiles.ca .
DONOR RECOGNITION
Please outline what kinds of recognition LoyaltyOne will receive from this sponsorship. (i.e. Donor wall, logo on web
site, social media call outs, event logo placement, logo in brochures, etc.)
APPROVAL OF SUBMISSION
I, the undersigned hereby confirm that the information on this application is correct and that all sections have been
completed, to the best of my knowledge.
Executive Director:
Signature:
Date
Chair of the Board:
Signature:
Date
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Appendix
LoyaltyOne supports:
 Organizations that are registered charities
 Projects or programs that take place in communities where LoyaltyOne has a business presence
 Charitable organizations that provide direct community service
 Programs with measurable social outcomes
LoyaltyOne does not provide support for:
 Political or fraternal organizations, Service Clubs, or third-party organizations that raise funds for
charity
 Private foundations
 Individual pursuits
 Private elementary or secondary schools
 Religious organizations, unless they provide services benefiting the entire community
 The publication of books or movie productions
 Endowment or capital campaigns
 The creation or repair of statues, monuments, art work or beautification projects
 Third-party organizations raising funds for charity
 Conference, seminars, events or golf tournaments
 Sports teams or leagues
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