On behalf of the organization requesting funding, I hereby certify that:
The information provided in our contribution request form is true to best of my knowledge. The organization requesting funding is a non-profit 501 (c) 3 tax-exempt charitable organization and does not advocate or support policies or practice activities that discriminate on the basis of an individual’s race, religion, color, age, sex, disability, national origin, sexual orientation, marital status, citizenship status, protected veteran status or status in any group protected by state or local law.
Organization does not employ or deal with any entities or individuals known to support terrorism or to appear on any terrorist watch lists.