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  1. Campaign/Project/Program Name

    Ronald McDonald House® Program Support

  2. What category best describes your campaign/project/program?


  3. What is the mission statement of your organization?

    The mission of Ronald McDonald House Charities of Central Texas (RMHC CTX) is to create, find and support programs that directly improve the health and well-being of children and families. We accomplish this through four signature programs: Ronald McDonald House, Ronald McDonald Family Rooms, Happy Wheels Carts and Healing Hearts. RMHC CTX provides families a home-away-from-home” with temporary emergency lodging”

  4. What year was your non-profit organization founded?

    food and support so they focus on the most important thing — the healing of their child.”

  5. Amount requested for your Campaign/Project/Program


  6. Attach a letter from your Executive Director or a Board Member summarizing your grant request.

    The letter must include the following information:

    • A detailed description of the campaign/project/program
    • A defined group of individuals that will benefit from the campaign/project/program
    • Any applicable timeline details.

  7. Attach a copy of your IRS Determination Letter.


  8. Attach your most recent 2 year’s completed 990/990-PF tax returns as required by the Pension Protection Act of 2006.

    If your organization has extended last year’s return, submit the prior 2 year’s completed returns. If an attachment containing the full return exceeds the file size limit allowed, provide an attachment that contains at least Form 990 and Schedule A (if a Public Charity) or at least form 990-PF. Other Schedules may be omitted. Note: The TIN on your tax returns must match the TIN on your organization’s profile and Form W-9 attached in #9.

  9. Attach a completed, signed, and dated Form W-9 with your organization’s TIN.

    Please use the most current version of Form W-9 that is published on

    Note: The TIN on your W-9 must match the TIN on your organization’s profile and the tax returns attached in #7.


  10. Select your organizations tax status. Please consult with your tax return preparer if you are uncertain of your tax status.


  11. If you receive a grant, in which Texas counties will your organization use the funds?

    Note: Funds received from the AKR Foundation are to be used exclusively in the following Texas counties. If the Campaign/Project/Program plans to use AKR Foundation grant funds in any counties not listed, your application is not eligible for funding.

  12. Provide your organization’s estimated budget for the campaign/project/program for which you are requesting funding (not your organization’s total budget).

  13. List the following information for your Executive Director, at least three key staff/board members, and your grant writer (if applicable)

  14. Please list the name, occupation, gender and race of each of your Board members.

  15. If you were invited to apply during this year’s grant cycle by one or more of our Advisory Directors, please list their name(s).

    Caucasian, Hispanic, Asian, Middle Eastern

  16. Has your organization previously received a grant from the AKR Foundation?


Questions 17-20 are optional, unless we contact you via email requesting one or more of these items. Please have the following information ready to submit in the event that we contact you.

  1. Attach your organization’s current annual operating budget.

  2. Attach a list of your Board of Directors, their Board term(s), and your election and nomination process.

  3. Attach a copy of your non-discrimination policy and specifically highlight any language related to sexual orientation.

  4. Please list all major contributions for the past year.