Please fill out the following material.
Your information will be e-mailed to: ccpb@uwcentralcarolinas.org
Organization Name
(as it appears on 501c3)
Federal tax identification number
Organization contact name to use in the CCPB review
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Phone
Fax
E-mail
Webpage URL (if any)
Proposed Campaign Goal ($ amount)
Desired dates of private phase of campaign
Desired dates of public phase of campaign
CCPB requires a minimum of six months to conduct a review. Please refer to website notice of next meeting dates.
