PUBLIC CHARITY QUESTIONNAIRE

The Monsanto Fund must determine that your public charity would be recognized as tax exempt under U.S. concepts before a grant can be made. Please fill in the following questionnaire to the best of your ability to help us determine your eligibility for a grant.

1.   State the full name and mailing address of your organization.

2.   List the name and address of the responsible officer or officers of your organization.

3.   Attach a true and correct copy of your organization’s creating instrument (Articles of Incorporation, Constitution, Articles of Association, Deed of Trust, Indenture, etc.). NOTE: If your organization does not have a creating instrument, its request for a grant from Monsanto Fund will not be considered.

4.   Attach a true and correct copy of your organization’s By-Laws, Statutes, or other rules governing its operations.

5.   Please state, in narrative form, the activities presently carried on by your organization, as well as any activities it is contemplated will be carried on in the future. List each activity separately in order of importance based upon relative time and resources devoted to the activity. Indicate the percentage of time for each activity. Each description should include a detailed description of the activity including it purpose. Also, please fill out Exhibit A.

  1. What benefits, services, or products does your organization provide with respect to its charitable function?
  1. Are the recipients of any benefits, services or products of your organization required to pay for them?
    If the answer is yes, please explain and show how the charges are determined.
  2. Does your organization limit its benefits, services or products to specific classes of individuals?
    If the answer to the above is yes, explain in detail how the recipients or beneficiaries are selected.
  1. Does or will your organization engage in activities involving the influencing of legislation or the intervention in any way in political campaigns?
    If the answer is yes, please explain in detail.
  1. For charitable donations received from the Monsanto Fund, will the charitable activities be conducted solely outside the United States?

If the answer is No, your organization will be asked by the Monsanto Fund to complete a Form W-8EXP from the US Department of Treasury Internal Revenue Service prior to the start of the project if this application is approved for a grant.


Exhibit A

Schedule of Sources

of Support

Previous Years
Most Recent Year / 1 / 2 / 3 / Total
1. Gross contributions,
gifts and grants received. / ______/ ______/ ______/ ______/ ______
2. Gross dues and assessments of members. / ______/ ______/ ______/ ______/ ______
3. Gross amounts derived from activities related to organization’s exempt purpose. / ______/ ______/ ______/ ______/ ______
4. Gross amounts from unrelated business activities. / ______/ ______/ ______/ ______/ ______
5. Gross amounts from interest, dividends, rents and royalties. / ______/ ______/ ______/ ______/ ______
6. Tax revenues levied for and either paid to or expended on behalf of the organization. / ______/ ______/ ______/ ______/ ______
7. Value of services or facilities furnished by a governmental unit to the organization without charge (not including the value of services or facilities generally furnished to the public without charge). / ______/ ______/ ______/ ______/ ______
8. Other income—attach schedule. / ______/ ______/ ______/ ______/ ______
TOTAL / ______/ ______/ ______/ ______/ ______

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