2027 Round Up Application Form NameThis field is for validation purposes and should be left unchanged.Organization Name(Required)501(c) or Tax ID#(Required)Mission Statement(Required)Contact Person(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Website(Required) Program Area (select one that best represents your organization)(Required) Social Services & Food Access Local Area Schools Food Systems & Agriculture Diversity, Equity, Inclusion Orgs in support of co-ops Community Health & Wellness Environmental Issues Local Arts & Culture Which community does your nonprofit primarily serve?(Required) Nevada County Placer County Both Other More about your organizationSelect all that apply. Our organization is BIPOC/Global Majority led and/or supports BIPOC/Global Majority communities Our organization supports low-income populations Our organization helps to provide food access in our community Our organization advocates for diversity, equity, and inclusion initiatives If you would like to elaborate on the above question, do so here:How can we help? Please describe the issue.Tell us about the core issue(s) your organization faces and how Round Up at the Register funds will be used to address said issue(s).(Required)Please include specific strategies, approaches, and activities.How does your work align with BriarPatch's values?(Required)These values include an inclusive and resilient regional food system, an equitable and expanding cooperative economy, and a vibrant and sustainable organic, natural foods grocery store.Two key accomplishments of the organization in the past 12 months?(Required)This field is hidden when viewing the formTwo key accomplishments of the organization in the past 12 months?High-resolution Logo(Required)Accepted file types: ai, pdf, jpg, png, Max. file size: 30 MB. High-resolution photos (3 to 5) that best represent what your organization does(Required)Please upload 3 to 5 high quality photos that show what your organization does and who it serves. Only share photos that are approved to be posted on our social media, website, and in-store. Minimum size: 1200 pixels Drop files here or Select files Accepted file types: pdf, jpg, png, tiff, gif, Max. file size: 30 MB, Max. files: 5. New Vendor Form & W9Please click the link and fill out the New Vendor Form and upload a W9. If you’ve filled out the online New Vendor Form in 2024-2026, then you do not have to do so again. Fill out New Vendor Form and W9 hereCheck box to agree(Required) I have completed the New Vendor Form link and uploaded the W9 Δ