Corporate Giving Program – Application

Section A: Information about your organization

01. Organization Name:*

02. Address:*

03. Phone Number:*

04. Website:

05. Facebook page (if applicable):

06. Twitter handle (if applicable):

07. LinkedIn URL (if applicable):

08. Please provide any other social networking profiles your organization uses (if applicable):

Other organization type:*

10. Registered Charity Number (if applicable):

11. Description of organization in minimum of 250 words (Who you are, What your organization does, etc.):*

Section B: Information about you (Contact details)

01. Name:*

02. Title:*

03. Phone Number:*

04. Email:*

Please specify:*

Please specify appropriate contact name:**

Phone Number:*

Email:*

Section C: Information about your request (Funding Proposal)

01. Please provide a name for this project or initiative:*

02. Please describe your project initiative in minimum of 250 words:*

03. Who will benefit from this funding?*

Please specify:*

05. Please specify the timeframe of your project initiative or start date of the project:

06. How will Elexicon Energy’s contribution be recognized. Please list all branding benefits (eg. Ads, social media, signage, printed materials, newsletters, annual report, website, podium recognition, etc.)*

07. What event attendance benefits (i.e. tickets) are included?

Please specify:*

09. What is the amount of funding you are requesting?*

10. What will the funding be used for? Provide an estimate of budget breakdown:*

11. What funding has been received in the past 12 months from Elexicon Energy?*

12. What employee engagement opportunities exist (if applicable)

13. How did you hear about Elexicon Energy’s Corporate Giving Program?

14. . Elexicon Energy is interested in following up on the projects that we support. When do you anticipate being in a position to provide us with an evaluation of its success (eg. Number of attendees, social media metrics, testimonials, number of families/communities helped, etc.).*

15. You are welcome to submit additional documentation to support this application.

You may add an additional document by selecting the choose file button below. Please upload the documents in a single PDF file (maximum file size permitted: 5MB) - To upload multiple documents, you will need to combine multiple documents into one PDF file.

Accepted file types: pdf, Max. file size: 5 MB.

Section D: Agreement

By submitting this application I confirm that I have the authority to submit this request and agree to the conditions described below.

All information contained herein is true and accurate to the best of my knowledge;
Should Elexicon agree to provide support for the initiative proposed in this application, I agree that information about this initiative may be used in the promotion of Elexicon’s corporate giving program;
I consent to receiving email notifications regarding this request and any subsequent emails from Elexicon that relate to this request or any future grants or sponsorships associated with this initiative.

* A separate Gift Agreement, Terms and Conditions will be required to be signed off once the application has been approved and prior to release of funds. This will be provided by Elexicon upon approval of your application.

Title:

Email:*

Phone Number:*

Date*

Email

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