Operation Round Up Application

To apply for RTC Networks Operation Round Up funds, complete this form. Funds are to be used for community betterment and/or economic development projects (i.e. cafe, grocery store, motel, ambulance services, fire districts, recreation, school/youth projects, etc.) Please note that funds will not be provided for medical fundraisers or general operating costs.

Name of Organization(Required)

Mailing Address(Required)

Mailing Address Address Line 2 City State Zip

Contact Person(Required)

Email(Required)

Phone(Required)

Project Title

Project Location(Required)

List areas served by project.

Project Summary (include how your project will impact the community):(Required)

Is this organization classified as a non-profit?(Required)

Yes

Is this organization:(Required)

A community-owned business or facility (i.e. ambulance, hospital, fire district, recreation, community center, etc.)

A community-based project (i.e. service group/club, youth/school programs, etc.)

Other

Total Project Cost(Required)

Operation Round Up Amount Requested(Required)

Other Funding Souces (grants, donations, in-kind, etc.)(Required)

Name of Organization(Required)

Name of Representative(Required)

First Last

By entering your name, you are effectively providing your signature.

Date(Required)

W-9

Max. file size: 100 MB.

A W‑9 form is required for all donations, regardless of the amount. If we already have a W‑9 on file for you, there is no need to resubmit it. If you are unsure, we recommend submitting the form now to avoid delays. https://www.myrtcnetworks.com/w9/

Optional File Upload

Drop files here or

Max. file size: 100 MB.

If you would like to include any additional information/documentation pertaining to your organization or project, please upload here.