Fiscal Sponsor form

The fiscal sponsor indicates to the Amelia Peabody Foundation, in consideration of the receipt of the funds, its agreement to act as such fiscal sponsor for the grantee and its agreement to process all such funds fully for the program or project stated in the request, according to the budget as submitted. This funding is a restrictive grant requiring that these funds be held in trust for the named program or project. No right is given to redirect these funds to another purpose or entity without specific approval from the Amelia Peabody Foundation. Without such approval, unexpended funds are to be returned to the Amelia Peabody Foundation.

These funds must be exclusively used in the Commonwealth of Massachusetts. Acceptance confirms the continued tax-exempt status of the fiscal sponsor. In the event such status is changed or revoked by the Internal Revenue Service or any state, the grant shall be immediately terminated and all unexpended funds shall be repaid.

Acceptance also confirms that this organization does not directly or indirectly engage in, promote or support any terrorist activity and that it is not included on any lists of terrorist organizations compiled by the United States government or any other national or international body. This certifies that this organization does not knowingly employ people whose names appear on such government watch lists.

Please return an executed original of this agreement at your earliest convenience.