Organizational Background
Physical address of your main operational site. An operational site is considered a location where most, if not all, of the important functions of your organization are coordinated. Please only include the address of a programming site if it is also considered an operational site.
An operational site is considered a location where most, if not all, of the important functions of your organization are coordinated.
If you are a program or department of a larger entity (i.e. local government, hospital, university), please focus your answer around the adaptive and inclusive sports programming you provide.
Provide a copy of an IRS document that includes the assigned Employer Identification Number (EIN) and proof of tax status
If you are a 501c3, provide a copy of the Articles of Incorporation filed with State of Incorporation
Provide a copy of the bylaws filed with State of Incorporation, if applicable
Provide proof of your organization's registration as a charity in the state of incorporation and the state where business headquarters are located, if they are not the same. Please note: This is NOT the same as the Articles of Incorporation.
Please select all that apply
Event Description
If there are multiple dates, indicate in Additional Dates/Locations field below.
MM slash DD slash YYYY
If there are multiple dates, indicate in Additional Dates/Locations field below.
MM slash DD slash YYYY
If there are multiple locations, indicate in Additional Dates/Locations field below.
If approved, this description will be used in the public event listing.
Select all sports programs currently that apply. Press and hold Ctrl to select multiple sports.
Please exclude staff and volunteers
Please exclude staff and volunteers
Programs
Use CTRL key to select more than one option.
Use CTRL key to select more than one option.
How many days a year do you offer adaptive and/or inclusive sports programming?
Participants
If you are a program or department of a larger entity (i.e. local government, hospital, university), please focus your numbers around the adaptive and inclusive sports programming you provide.
Please exclude staff and volunteers
Provide an example of your participant intake form. If form is in web format only, please use field below to indicate a URL address.
If your athlete registration is in web format, please provide the link below.
Approximately how many participants with disabilities do you serve annually in each age group?
Approximately how many participants with disabilities do you serve annually in each disability group?
Traumatic or Non-Traumatic
Including Autism, Down Syndrome, Severe ADD/ADHD, Nonverbal Learning Disability
Including SCI, Spina Bifida, Transverse Myelitis, Amputation, Cerebral Palsy
Including Amyotrophic Lateral Sclerosis ALS, Charcot-Marie-Tooth disease, Multiple Sclerosis, Muscular Dystrophy, Nerve Damage, Polio, PTS, Stroke
Number of Staff & Volunteers
Operations
The questions in the section focus on organizational administrative and fiscal health. If you are a program or department of a larger entity (i.e. local government, hospital, university), please focus your answers around the adaptive and inclusive sports programming you provide.
What are your organization's total annual expenses for your last completed fiscal year? If you are a program or department of a larger entity (i.e. local government, hospital, university), please focus your answers around the adaptive and inclusive sports programming you provide.
Please attach a board approved budget for the current fiscal year, and a year-to-date profit and loss statement. If you are a department or program of a larger institution (i.e. hospital, university, govt. entity etc.) your budget should be specific to the adaptive/inclusive sports program.
If you are able, please most current 990, 990-EZ or 990-N. This does not apply to programs that operate as part of government entities.
Provide a roster of your board members. Click plus sign to add entries.
If you are a 501c3, conduct a board meeting and provide a copy of the minutes that reflect the passing of a motion to apply to become a member of Move United. If you are a department/program of a larger institution (i.e. hospital, university, govt. entity, etc.) you may instead submit a letter from that institution's leadership approving your application for membership.
Hidden
Provide proof of current Commercial General Liability Insurance (minimum limit of $1,000,000 per occurrence limit and $2,000,000 aggregate limit). If you are part of a larger entity (i.e. local govt., hospital) we can accept a letter from the insurance administrator/provider that confirms coverage of your adaptive/inclusive sports program.
Provide 5 year Loss Run Reports for all policies held (i.e. General Liability, Accident Medical, Directors & Officers). If you are part of a larger entity (i.e. local govt., hospital) we can accept a letter from the insurance administrator/provider that speaks to the claims specific to your adaptive/inclusive sports program.
Trainings & Protections
We have certain standards around trainings and screenings. We do take into consideration the willingness of organizations to put in place policies and procedures that help ensure they are delivering safe and effective programming.
Optional. Provide code of conduct for staff and/or participants, if able.
List certifications held, related to the programming being offered, and the certifying body/NGB related to that certification (ex. Adaptive Level 1 - PSIA). Click plus sign to add entries.
Provide an example of your volunteer intake form. If form is in web format, please provide the link below in the "Additional Comments" Section.
Optional. Please provide a copy of your volunteer manual, if you are able.
If so, please describe or attach documentation in the field below.
Attach any documentation related to volunteer training and education.
Describe any policies you have in place to ensure the safe delivery of programs (i.e. helmet policy, lift operator training, etc.) or attach documentation in the field below.
Attach any documentation related to risk management protocols.
Upload an copy of your liability waiver.
If you utilize a standard form to document any unexpected occurrence (injury, sickness, assault, etc.) regardless of whether or not medical attention was required, please provide a copy of that form.
If so, please describe.
Attach any documentation related to abuse prevention protocols.
If so, please describe.
Attach any documentation related to abuse prevention training/education.
Include information on how you handle reports as they come in, and who is involved the reporting process.
If so, please describe who this process applies to.
Safety Protocols
This section focuses on ensuring your event is conducted in a safe and effective manner.
Attach any documentation related to event safety protocols.
Attach any documentation related to abuse prevention protocols.
Provide proof of current Commercial General Liability Insurance (min limit of $1 million per occurrence and $2,000,000 per annual aggregate with no “participant or spectator exclusions”, covering liability arising out of premises operations, personal and advertising injury, products completed operations, contractual liability and independent contractors. )
References
Provide TWO organizational reference letters that endorse the services provided by your organization. Letters can be authored by another organization, participant, or anyone who can speak to the quality of services provided by the applicant organization.
Additional Info/Comments
The below fields are optional. Feel free to add comments or upload documents you feel will add value to your application.
Application Submitted by
Including, but not limited to: Sport Protection Policy, Training & Education Standards, Annual Renewal Requirements, Insurance Requirements
Upon hitting submit, you will receive an e-mail confirming your submission.
The email is proof of your submission. If you do not receive a confirmation email, the application may not have successfully gone through. Please contact ddodge@moveunitedsport.org if you do not receive.
