December 15, 2017

To prospective colleges, universities and state service organizations (CUSSOs):

Thank you for your partnership with the Colorado Combined Campaign (CCC), the workplace giving campaign of Colorado state government employees. We are pleased to present you with this document: the 2018-2019 CCC CUSSO Application Form.We look forward to receiving your application. Remember that CUSSOsare required to apply every year, regardless of prior campaign-year status. Please note below important details and reminders about the application and the application process.

  • A CUSSO is an entity that meets several criteria. It has registered as a nonprofit organization in Colorado by obtaining a Certificate of Registration from the Secretary of State; is exempt from federal income tax under Internal Revenue Code 501(a) as described in Section 501(c)(3); is directly associated with a department of the state of Colorado government; and, otherwise meets the criteria established in CCC bylaws. CCC bylaws, revisedNovember 2017, can be downloaded at:
  • Cover Letter: Please address your application cover letter to Doug Platt, Chair, Colorado Combined Campaign. Mr. Platt oversees the CCC Advisory Committee. This all-state-employee entity reviews and approves CCC applications, in March of each year. Applicants are then notified of their status by April at the latest.
  • Administration and Fundraising Ratio (AFR): All member nonprofits must use their most recent IRS Form 990 or IRS Form 990 pro forma to calculate the AFR required in the application. The CCC has provided an equation for calculating this ratio (see page 12).
  • Explanation of Administration and Fundraising Ratio: CCC bylaws state that the AFR of participating nonprofits shall not exceed 35% of the total expenses of the charitable organization. Any member nonprofit with an AFR over 35% is REQUIRED to submit an explanation as to why 35% has been exceeded (see page 13). Upon receipt of an adequate explanation, the committee, at its discretion, may grant a waiver of the 35% AFR maximum.
  • Application Training:In January we will host a webinar to review the application process, provide information and answer questions. This webinar is scheduled for Wednesday, January 17, 2018, from 9 a.m. to 10 a.m. Mountain Time. Our meeting ID is 876 481 735. To participate from PC, Mac, Linux, iOS or Android, use this link: To dial in, call 1-669-900-6833, 1-408-638-0968 or 1-646-876-9923.

Reminders

  • Electronic and hard copy of the Nonprofit Information Worksheet: Nonprofit information for CCC marketing materialsmust be submitted electronically as an Excel document (using the template we provide) and included as a hard copy with your submitted application. Email your completed Nonprofit Information Worksheet (formerly called Attachment A) to .
  • Registration with the Colorado Secretary of State: Applicants must provide proof of two items from the Colorado Secretary of State: currentregistration as a nonprofit business in good standing (“Periodic Report Number”) andcurrent charitable registration (“Renewal ID Number”unless exempt, in accordance with the Charitable Solicitation Law). In addition to certifying item VIII (A) (7) from the bylaws, we are also collecting registration information from applicants. The Nonprofit Information Worksheet includes a column for the “Periodic Report Number” and “Renewal ID Number” for all applying charities.

Please do not hesitate to contact me with any questions or concerns you might have about the CCC, the application and the application process. Along with our Advisory Committee and on behalf of the CCC, I look forward to working with you on another successful campaign!

Sincerely yours,

Becky Herlinger

Director, Colorado Combined Campaign

720-420-3210

THE COLORADO COMBINED CAMPAIGN MUST RECEIVE YOUR APPLICATION
BY 5 P.M. ON FRIDAY, FEBRUARY 16, 2018

Colorado Combined Campaign
c/o Community Shares of Colorado
789 Sherman Street, Suite 230 - Denver, Colorado 80203

Your application needs to be provided in hard-copy form. Either mail or hand-deliver it. Please remember to provide the Nonprofit Information Worksheetas both a hard copy with your application and via email to .

APPLICATION CHECKLIST

The College, University and State Service Organization (CUSSO) Application consists of the following components, which should be submitted in the order listed below. This checklist and accompanying instructionswith full details is provided to help ensure a complete application. It does not need to be submitted with the application.

Section I: Cover Letter (one page)

Please address your application cover letter to Doug Platt, Chair, Colorado Combined Campaign. Mr. Platt oversees the CCC Advisory Committee.

Section II: Contact InformationForm

Use the one-page template provided (see page 7).

Section III: Bylaw Certifications Form

Read, initial and sign the form provided (see pages 8-10).

Section IV: Narrative

Formatting:Use 12-point font with 1-inch margins and include the HEADING provided for each question. It is not necessary to repeat the text of the questions

Page Limit:3-page limit

Narrative Questions:

PROGRAMS AND ACTIVITIES: A full description of the charitable organization’s programs and activities.

KEY ACCOMPLISHMENTS: Key accomplishments in the 2017 calendar year.

REPORTING AND TRANSPARENCY: A full description of the organization’s diligence and methods of reporting to the public with an emphasis on financial and management transparency.

 Section IV: Attachments

Financial Attachments

IRS Form 990or IRS Form 990 pro forma

Audit or Financial Review

Sources of FundingTable (see page 11)

Disclosure of Expenditures Table (see page 11)

Disclosure of Administration and Fundraising Ratio Form(see page 12)

Explanation of Administration and Fundraising Ration Form, if applicable (see page 13)

Current Budget and the Board Minutes Approving Submitted Budget

Other Attachments

Nonprofit Information Worksheet

IRS Determination Letter

Non-Discrimination Policy

Certificate of Good Standing

Certificate of Registration

Other Attachments continued

Board of Directors List

Leadership Staff List

State Association Statement Form (see page 14)

Statement of Local Presence Form, if applicable (see page 15)

Annual Report, if available

ATTACHMENT INSTRUCTIONS

Financial Attachments

  1. IRS Form 990 or IRS Form 990 pro forma
  2. The organization’s most recently filed IRS Form 990 dated 6/30/2016 or more recent and covering the same fiscal period as the submitted audit or financial review.
  3. Audit or Financial Review
  4. The organization’s most recent audit or financial review dated 6/30/2016 or more recent and covering the same fiscal period as the submitted IRS Form 990.
  5. Sources of Funding Table
  6. Complete and submit the table,on page 11, for the organization as a whole, based on the most recently completed fiscal period. Categories may be modified to fit your organization’s funding sources.
  7. Disclosure of Expenditures Table
  8. Complete and submit the table,on page 11, for the organization as a whole, based on the most recently completed fiscal period.
  9. Administration and Fundraising Ratio (AFR) Form
  10. Complete and submit the form provided,on page 12, including the calculation.
  11. Information provided must be obtained from your most recent IRS Form 990 or IRS Form 990 pro forma.
  12. Explanation of Administration and Fundraising Ratio Form, if applicable.
  13. If your AFR is greater than 35%, complete and submit the form, on page 13.
  14. Be as detailed as possible in your explanation.
  15. Current Budget
  16. A copy of the organization’s budget for their current fiscal period.
  17. A copy of the minutes of the organization’s board of directors meeting showing approval of the budget. Please highlight the section demonstrating board approval.

Other Attachments

  1. Nonprofit Information Worksheet
  2. Download the Excel sheet pre-formatted at:
  3. Remember, the information from the Excel sheet will be imported into the 2018-2019 CCC resource guide, online giving site, website and social media. Be sure to carefully proof information before submitting.
  4. Submit the Nonprofit Information Worksheet as an Excel sheet via email to: and as a hard copy with your application.
  5. Detailed instructions on how to complete the worksheet can be found on the second tab labeled “Instructions” in the Nonprofit Information Worksheet workbook. To access the instructions click on the tab labeled “Instructions” at the bottom of the workbook.
  6. IRS Determination Letter
  7. Name and address should match the name and address listed on your submitted IRS Form 990.
  8. A link to contact the IRS for an updated letter is included on the “nonprofit resources” page on the CCC website at
  9. Non-discrimination policy
  10. A copy of the organization’s non-discrimination policy protecting, at minimum, the classes listed in the CCC bylaws: “race, color, religion, national origin, disability, age, gender and sexual orientation applicable to persons served by the organization.”
  11. Certificate of Good Standing
  12. A copy of your organization’s Certificate of Good Standing dated 1/1/2016 or more recent.
  13. Certificates of Good Standing can be obtained at
  14. To obtain a Certificate of Good Standing, go to: go to: and do the following:
  15. Click on “Businesses, trademarks, trade names.”
  16. Under “Search & file” click on “Search business database.”
  17. Enter the charity’s name in the text box and click “search.”
  18. Click on the "# ID Number” by the charity’s name. If there are multiple records, click on the "# ID Number" by the charity's name where the “Status” is "Good Standing."Note: If the description is anything other than "Good Standing,"the charity must renew its registration before it will be eligible for participation.
  19. Scroll down and click on “Get a certificate of good standing.”
  20. Certificate of Registration
  21. A copy of your organization’s Certificate of Registration dated 1/1/2016 or more recent.
  22. Certificates of Registration can be obtained at
  23. To obtain a Certificate of Registration do the following:
  24. Click on “charities and fundraisers.”
  25. Under “Consumers,” click on “Search charities database.”
  26. Enter the charity’s name in the text box and click “search.”
  27. Click on the charity’s name.
  28. Scroll down to and click on "Get certificate of registration."
  29. Board of Directors List
  30. A list of current board members including names, professional affiliations and contact information.
  31. Leadership StaffList
  32. Names, titles and contact information for current leadership/key personnel.
  33. State Association Statement Form
  34. Complete the form, on page 14, by providing information on how your organization has a direct association with a State of Colorado department by identifying the type of association, the name of the department and as description of that association.
  35. Statement of Local Presence Form, if applicable
  36. To be completed only by organizations who do not have a physical address or presence in the state of Colorado.
  37. Complete the form, on page 15, by providing a description of how your organization does have a presence in the state of Colorado through services and funding.
  38. Include documentation or verification that supports your description of your local presence with your application.
  39. Most recent Annual Report, if available.

CONTACT INFORMATION FORM
CUSSO Name:
Mailing Address:
City:
State:
Zip code:
Main Telephone Number:
Fax:
Website URL:

Contact Person Name:
Contact Person Email:
Contact Person Direct Telephone Number:

I, ______, the duly appointed representative of ______have verified and I certify and affirm all statements enclosed in this application to be true.

Signature / Title / Date of Application
Name

ByLaw Certifications FORM

Listed below are the requirements to participate in the Colorado Combined Campaign as set forth in CCC bylaws, revised November 2017. A copy is available for your reference at The items below are listed in corresponding order with the bylaws Section VIII (A) (1-15) and Section VIII (B) (1-9) for your convenience. Please initial the box next to each certification statement.

The CCC Advisory Committee reserves the right to deny participation to an organization for false certification.

Section VIII (A) Criteria and Procedures for All Charitable Organizations

INITIAL

  1. I certify that the organization named in this application has a policy and procedure of non-discrimination with regard to race, color, religion, national origin, disability, age, gender and sexual orientation applicable to persons served by the organization.
  2. I certify that the organization named in this application uses the funds contributed to the charitable organization by state employees for their intended purposes within Colorado. No more than 15% of CCC funds may be used for the organization’s administration costs.
  3. I certify that the organization named in this application will limit direct monetary solicitation of support from state employees to the CCC.
  4. I certify that the organization named in this application can demonstrate a history of service in the State of Colorado as a charitable organization under the criteria set forth in this Section VIII for no less than 12 months prior to the date of application.
  5. I certify that the organization named in this application is exempt from federal income tax under Internal Revenue Code 501(a) as described in Section 501(c)(3).
  6. I certify that the organization named in this application is registered as a nonprofit organization with the Colorado Secretary of State by obtaining from that office a Certificate of Good Standing.
  7. I certify that the organization named in this application is registered, unless exempt, with the Colorado Secretary of State in accordance with the Colorado Charitable Solicitation Act.
  8. I certify that the organization named in this application uses a financial accounting system that is in accordance with generally accepted accounting principles unless the organization’s annual expenditures are less than $100,000, in which case a cash basis of accounting is acceptable provided that books and records are sufficient to allow for review by an auditor.
  9. I certify that the organization named in this application conducts financial operations in accordance with a detailed annual budget that is approved by its board of directors and authorization by the organization’s board of directors is required for any significant variation from its approved budget.
  1. I certify that the organization named in this application is supported in part by voluntary contributions from the public.
  2. I certify that the organization named in this application engages only in activities that are consistent with its stated goals and objectives.
  3. I certify that the organization named in this application can demonstrate that its publicity and promotional activities are based upon its actual programs and operations.
  4. I certify that the organization named in this application provides annually updated information which is available to the general public and includes:
  5. A full description of the charitable organization’s activities.
  6. Methods of solicitation for contributions.
  7. The names and contact information for all chief administrative personnel.
  8. The names, contact information and business affiliation for all members of the board of directors.
  9. A full disclosure of the sources and uses of contributions.
  10. The percentage of expenditures out of total revenues used for direct services and the percentage used for administrative and fundraising costs
  1. I certify that I have provided to the CCC the percentage of total revenues not spent on direct services, referred to as the Administration and Fundraising Ratio (AFR).
  1. The AFR was calculated using the most recent IRS Form 990 or IRS Form 990 pro forma.
  2. If the administrative cost exceeds 35% of total revenue in any given year, the charitable organization must submit an explanation as to why 35% has been exceeded. Upon receipt of an adequate explanation, the committee, at its discretion, may grant a waiver of the 35% maximum.
  1. I certify that the organization named in this application if accepted for participation:
  1. Will not imply directly or indirectly that approval for payroll contribution constitutes endorsement of the organization by the state of Colorado.
  2. Will not sell or permit others to make use of the lists of contributors who donate through the CCC.
  3. Will not involve the mailing of unordered tickets or other merchandise to state employees with a request for money in return.
  4. Will maintain an active volunteer board of directors that serves without compensation through regular meetings and exercises satisfactory administrative controls in accordance with the charitable organization’s articles of incorporation and bylaws.
  5. Will demonstrate that its programs reside within and serve the state of Colorado as evidenced by the presence within the state of Colorado of a staffed facility at which goods or services may be obtained such as an office, clinic, mobile unit or field agency.
  6. Is a member of an umbrella federation that is approved for payroll contribution according to the criteria set forth in Section VIII (A) and (B) of CCC bylaws or is designated as a college, university or state service organization (CUSSO).
  7. Will not participate in more than one umbrella organization that receives state employee contributions in a single campaign year.
  8. Will not use donated state employee funds for lobbying activities.
  9. Will be in compliance with all applicable federal and state statutes or regulations.
  10. Will be in compliance with all statutes of the United States of America Patriot Act.

Section VIII (C) Additional Requirements for Colleges, universities and State Service Organizations

  1. I certify that the organization named in this application has a direct association with a department of the government of the state of Colorado. In order to be considered, the organization must:
  2. Be supported by the state of Colorado by state ownership of capital improvements or equipment, or state sharing of operating or maintenance funding; or
  3. Have a direct relationship to a state agency by providing enhanced services of that agency; or
  4. Act as an agent of the state to operate, manage or administer a function of the state.
  1. I certify that the organization named in this application will submit annually to the Colorado Combined Campaign a separate application that consists of documents that proves it is in compliance with all criteria set forth in Section VIII (A) and (C) for a CUSSO.