Application to Become Designated a Qualified Organization

The New Jersey Cultural Trust Board votes to designate organizations as “qualified.” This means that the Board has determined that the organization meets the requirements set forth in the Cultural Trust Act to participate in and benefit from Cultural Trust programs. Designation as a qualified organization is required to take advantage of funding opportunities provided by The New Jersey Cultural Trust. Individual grant programs offered by the Cultural Trust may include additional eligibility requirements in addition to qualification.

Before completing this application, please read the Guidelines for Becoming Designated a Qualified Organization and carefully review the eligibility criteria.

For more information about the Cultural Trust, please go to the Cultural Trust website.

To apply, complete the following application form, including all required uploads. NOTE: Once you begin the online application, you will not be able to save it and return to it later. DO NOT BEGIN the application until you have assembled all of your application materials, including a Qualification Application Certification Form signed by a member of your organization’s board. Please refer to the Online Qualification Application Checklist included in the Guidelines for Becoming Designated a Qualified Organization to prepare your materials.

You may submit this form at any time. Your application to be designated qualified will be considered at the next scheduled board meeting.

Please note that all information submitted to The New Jersey Cultural Trust is subject to the Open Public Records Act and will be made available upon request for public access with the exception of materials exempted by law, executive order, or by rule.

Organization Information

Legal Name of Organization:

Organization's "Doing Business As" (DBA) name or "Formerly Known As" (FKA) name (if applicable):

Mailing Address

Mailing Address Line 2

City

State Value is not selected

Postal/Zip Code

County Select the county in which your organization is primarily located. Value is not selected

Organization Phone Number:

Website:

General Email:

Date of Incorporation:

How many consecutive years has your organization been operating?

Fiscal Year-End: E.g., Dec. 31

Find your NJ Legislative District: https://www.njleg.state.nj.us/district-map
Find your Congressional Legislative District: https://www.house.gov/representatives/find-your-representative

NJ Legislative District:

Congressional Legislative District:

Confirm that your organization's primary mission is in New Jersey. You must meet at least two of the four below numbered criteria in order to be eligible for Board consideration. Select all that apply to your organization:

1. The organization maintains a primary location is in New Jersey OR more than 50% of the organization's staff is based in New Jersey.

2. More than 50% of the organization's audience is composed of New Jersey residents.

3. More than 50% of the organization's budget is expended in New Jersey.

4. More than 50% of the organization's programming occurs in New Jersey.

If you checked #1 above, please indicate which of these statements is true about your organization (select all that apply):

A. The organization maintains a primary location in New Jersey.

B. More than 50% of the organization's staff is based in New Jersey.

NOTE: Further evidence supporting each check box must be supplied to the Cultural Trust upon request.

Principal Contact

Contact Person First Name:

Contact Person Last Name:

Position/Title:

Contact Person Direct Phone Number:

Contact Person Direct Email:

Re-Enter Contact Person Direct Email:

EIN and 501(c) Status

FEIN (Federal Employer ID #): This is the number assigned to your organization by the federal government. You use this number for your IRS Form 990 filings. It is 9 digits long.

IRS Letter of Determination: Upload a copy of your organization's IRS tax determination letter as proof of the organization's tax-exempt, 501(c) status from the Internal Revenue Service. Maximum of 1 upload.

New Jersey Charities Registration

Charities Registration, a unit within the New Jersey Division of Consumer Affairs, regulates nonprofit organizations. Registration is required for Cultural Trust qualification. Search for your Charities Registration number and file standing here. If you need help registering or rectifying a non-compliant file standing, please contact Charities Registration at charitiesportalsupport@dca.njoag.gov.

Charities Registration #: This is the number assigned to your organization by the NJ Division of Consumer Affairs, Charities Registration Division. It is a 7-digit number beginning with CH.

Charities Registration File Standing: Your organization's file standing must be "Compliant" in order to become qualified. Value is not selected

New Jersey Division of Revenue and Enterprise Services (DORES)

DORES is the State agency that maintains business registrations and other records for businesses operating in New Jersey. Learn more about DORES and search for your DORES Entity ID number here.

DORES Entity ID #: This is the number assigned to your organization by the NJ Division of Revenue and Enterprise Services at the time of incorporation and business registration. It is a 10-digit number usually beginning with a zero.

DORES Proof of Good Standing: Upload proof of your organization's active good standing with the NJ Division of Revenue and Enterprise Services (e.g., a business standing certificate or a copy of the organization's most recent certificate of annual report filing). Maximum of 1 upload.

Organization Mission

Organization's board-adopted mission statement: The organization's mission statement should clearly identify the organization as one with a primary purpose of arts, history, or humanities.

Statement of primary purpose (not more than 1,500 characters):

Please provide a short written statement explaining how the organization’s mission and activities (as enumerated above and below) demonstrate a primary purpose of arts, history, or humanities. See pages 1 and 2 of the Cultural Trust's Guidelines for Becoming Designated a Qualified Organization for the Cultural Trust's definitions of these disciplines. Factors that may contribute to an organization’s eligibility include:

     • The majority of the organization’s programming consists of arts/history/humanities programming and/or services.
     • The majority of the organization’s audience is driven by arts/history/humanities programming.
     • The majority of the organization’s earned income comes from arts/history/humanities-based programs and services.
     • The majority of the organization’s expense budget supports arts/history/humanities-based programs and services.

Organization Activities

Summaries of Activities

Please provide summaries of the organization’s activities for the past two years describing all major programs and services (e.g., published annual reports about programming, reports sent to annual grant funders, reports delivered to the Board of Trustees, bullet-pointed lists, etc.).

Year 1 Activities Summary: Maximum of 1 upload.

Year 2 Activities Summary: Maximum of 1 upload.

Documentation of Activities

Please provide up to 5 pieces of documentation for the public — such as event calendars, brochures, email blasts, educational outreach materials, or performance and exhibition calendars — that support the organization’s mission and verify its services to the public.

Documentation of Activities: Maximum of 5 uploads.

Organization Governance

List of Current Board Members (Including Officer Positions): Upload a list of all current members of your organization's board. Please indicate which members are officers and which officer positions they hold. Maximum of 1 upload.

Board Meeting Minutes — Most Recent Budget Approval: Upload a copy of the minutes for the board meeting at which your organization's most recent annual budget was approved. Maximum of 1 upload.

Financial Documentation

Please provide certified independent audits for the organization’s two most recently completed fiscal years, or:

Organizations with annual gross contributions of less than $1 million and no endowment or endowment holding in excess of $100,000 may instead provide:
- copies of the organization’s tax returns (i.e. Forms 990) for the past two fiscal years;
- and the organization’s past two annual budgets as approved by the organization’s board of directors.
Organizations with annual gross contributions of less than $25,000 and no endowment or endowment holding in excess of $100,000 may instead provide copies of the organization’s past two annual budgets as approved by the organization’s board of directors.

NOTE: For organizations submitting annual budgets, a budget must be a complete planning document for the entire organization for an entire fiscal year, including both income and expenses

Year 1 Financial Documentation: Upload either the organization's audit OR alternative documentation as outlined above. Maximum 2 uploads.

Year 2 Financial Documentation: Upload either the organization's audit OR alternative documentation as outlined above. Maximum 2 uploads.

NOTE: Schedule B must be removed from Form 990s before they are uploaded.

Application Certification

Authorizing Official

Authorizing Official Name:

Title of Authorizing Official:

Certification:

By checking this box, the person listed above attests to and certifies that all statements made within this submission or provided as proof and corroboration of statements made with this submission are to the best of their knowledge and belief true and accurate.

Authorizing Official Signature:

Date:

Authorizing Board Member

Authorizing Board Member Name:

Upload Signed Qualification Application Certification Form Upload a Qualification Application Certification Form completed by an authorizing member of your organization’s board. Maximum 1 upload.

Download a blank Qualification Application Certification form here.

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