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Discretionary Funding Expense Application Fiscal Year 2017

  • Instructions


    This application must be completed by an officer or employee of the organization that is applying for discretionary funding. All requests for funding must to legible, organized, complete and accurate. Keep a copy of the completed application for your records before it is submitted. All sections of the application are mandatory unless otherwise noted.

    The person who completes this form must be authorized by the organization to complete it and must know enough about the organization to be able to fully, truthfully and accurately complete the form.

    Requests for funding that are submitted to the City Council are considered public documents.

    Note: This application must be viewed in Firefox or Chrome


    This application cannot be saved, however you can go back to a previously finished section to make changes. You must complete the entire application in one session. DO NOT close the browser window or navigate away from the page until you have finished and submitted the application.

    Applications must be submitted from January 4, 2016 through February 22, 2016. Please be advised that no late applications will be accepted.

    In the checklist you will be provided with everything you will need to have access to in order to complete the application. The same application used to apply to an individual Member, the Speaker, or for a Council Initiative.


    Requests for Funding from Council Members

    Check the appropriate box(s) in Section C.


    Requests for Funding Related to Speaker Initiatives and City-Wide Initiatives

    Check the appropriate box(s) in Section C.

    Please direct any questions to

    Once the application is complete you will be prompted to print and sign certain documents that are to be sent to the Council. DO NOT send a printed version of the application. Only mail the documents that are necessary. Printed documents can be mailed to:

    Charles Davis
    NYC Council, Chief Compliance Officer
    250 Broadway, 15th Floor
    New York, NY 10007

  • Application Checklist


    Below is a list of information you will need access to in order to complete the application. Be sure to have this information handy as you cannot save this application.

    Information required:

    1. Federal Employer Identification # (FEIN)
    2. New York State Charities Bureau Registration Number
    3. Budget of Organization requesting funds
    4. HHS Accelerator Prequalification Status and Approved Service Areas
    5. Documentation concerning Independent Inquiries, Monitorships, Government Investigations, Inquiries or Audits (other than routine annual audit)
    6. Staffing information for the program you are requesting funds for
    7. Certificate of Incorporation (for those incorporated on or after July 1, 2013)
    8. Adobe Reader is required for viewing and printing the Portable Document Format (PDF) documents at the end of this application. To download the latest version of Adobe Reader, please click here
  • Section A: Organization Information

    Applicant Federal Employer Identification Number (FEIN)
    Does the organization now use, or in the past, used an FEIN other than the one provided
    Is the organization tax exempt under the Internal Revenue Code?
    If "YES", is the organization's tax exempt status current with the Internal Revenue Service?
    Has the organization ever had its tax exempts status revoked?
    Organization Web site
    Administrative Address
    Does the organization share office space, staff, equipment, or expenses with any other organization?
    Has the organization ever applied for Council funding in the past?
    Contact Person:
  • Section B: Prequalification and Charitable Status

    Was the organization incorporated before July 1, 2014?
    Did your organization receive or apply for Prequalification through HHS Accelerator?

    If "Yes" or if you have applied for prequalification, skip this section and select the Continue button to go directly to Section C. If "No" complete this section.
    Charitable Status
      To be eligible for funding organization must provide either a Charities Bureau identification number or qualify for an exemption.

    Is the organization registered with the Charities Bureau of the New York State Attorney General?
    Is the organization exempt from registering with the Charities Bureau?
  • Section C: Funding Information

    (If you select no, you must select Council Members or Delegations below to receive your funding request).

    Speaker Initiatives and/or City-Wide Initiatives List
    (Hold down the Ctrl (windows) / Command (Mac) button to select multiple options)  


    If you select a delegation the application will go to the delegation chairs office only, not every individual member of the delegation

    (To select multiple members, select the control key and click each member name.)

    Independent Inquiries, Monitorships, and Government Investigations, Inquiries, and Audits
    Within the last 5 years, has the organization been the subject of and independent inquiry, monitorship or government investigation or audit (by any local, state or federal government including any current or past audit by the City Comptroller, request for information or other inquiry from the Department of Investigation and any audit or inquiry by a licensing agency) other than a routine annual audit?







  • Section D: Purpose and Use of Funds

      (Please limit response to only information related to the purpose of funds.)
    Did you receive funding for Fiscal Year 2015

    For more information on service classification please check here.

    Hold down the Ctrl (windows) / Command (Mac) button to select multiple options
    (months, days of the week, hours, summer, seasonal, etc.)
    (e.g. Citywide; Brooklyn; Council District 39; Community Board 6; Flatbush, etc.)
    Are the services that the funds are being requested for open to all members of the general public regardless of enrollment, membership or any affiliation?
    if more than one, list all locations
    (Please include a copy with the rest of the mailed portion of the application.)
    Briefly describe the staffing for the program, including number and qualifications, paid or volunteer, etc.
    Has the organization provided the proposed or similar services in the past?
    Performance Evaluations
    (include agency, rating and date)
  • Section E: Affiliation

    Will the program be located in, operated by, or affiliated with a religious school?
    What percentage of the program participants do you estimate also are
    members of or participate in the religious organization or place of worship?
    If "YES", (to either question) please describe what types of outreach and/ or advertising is done to invite the community/general public to participate in the programming/services being offered?
    Please submit supporting documentation of outreach and/or advertising done to invite community/general public participation.
  • Section F: Confirmation/Notary


    Before your application can be submitted, please print the below forms:

    1. Certification of Authorization (Must be Notarized)
    2. Conflicts of Interest Disclosure Form (Must be signed even if there are no conflicts to disclose.)
    3. Charities Exemption Form (only for those who are exempt from registering with the Charities Bureau) (Must be Notarized)



    Before you submit, print a copy of this form for your records. You will NOT be able to print the form after submission.

    Print Discretionary Funding Disclosure Form