IC Empower Fund Donation Form

IC Federal Credit Union is committed to our members and the communities we serve and are delighted to offer support to benefit our local area through our Empower Giving Fund.

Please be sure to use this form for all Donation, Sponsorship or Volunteer Requests. Please submit all requests at least 30 days in advance and we will respond within 14 days. (Please Note: submitting a request does not guarantee funding.)

Before you begin this application, please be sure to have the following information ready to upload as you do not have the option to save the application once started:

W-9/Tax ID# or 501(c)3 IRS Designation Letter.
Any additional donation information, forms or flyers.
ACH Form - If you prefer to receive funds via ACH, complete this ACH Form and attach it to the end of the application.

After submitting your request details, a Donation Receipt for your records will be sent via email. Please direct any questions to [email protected].

Are you a non-profit or 501(c)3 organization?(Required)

Yes

Proof of 501(c)3 status or non-profit status(Required)

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 100 MB.

Organization Name(Required)

Chief Executive Officer(Required)

Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Contact Name(Required)

This email will be used as the confirmation email.

Contact Email Address(Required)

Mission & History(Required)

Website Address(Required)

Relation to credit union, if any

Donation Title(Required)

Amount(Required)

Payment Due Date(Required)

Donation Type(Required)

Key Giving Priority(Required)

Education and Financial Literacy *1

Health and Human Resources *2

Arts and Culture *3

Civic Duty *4

¹ Organizations or programs that feature a curriculum of education or financial literacy for community residents.
² Organizations or programs that promote public safety; support the health & safety or emergency care of children and veterans; provide meal programs; or focus on disease prevention and eradication.
³ Organizations or programs that encourage participation in local arts and culture initiatives.
⁴ Organizations that promote local environmental and open space initiatives.

How will this donation be used and how will it serve the community?(Required)

Please attach all supporting documents below

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 100 MB.

Payable To(Required)

Full Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Special Instructions, if any

Please upload your ACH Form below to receive funds via ACH

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 100 MB.

IC Empower Fund Donation Form

Request for In-Kind Items