Pitt County Forms Center

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   4561 County Home Rd. Greenville, NC, 27858.  |  Telephone: (252) 902-1975

   Pitt County External Agency Funding Application
    

4. Instructions 

   Submit online application below or print and mail to Pitt County Cultural Arts & Recreation, 4561 County Home Rd. Greenville, NC, 27858. 

   All of the following items must be submitted by January 22, 2026 for funding consideration: 

   1) External Agency Funding Application 
   2) List of Board of Directors 
   3) Organizational chart 
   4) Copy of agency's by-laws and mission statement/core values (If not already on file.) 
   5) Copy of detailed budget All requested funds will be evaluated and recommended based upon their own merit. 

   Applying for funds is in no way a guarantee for future funding. 
   The County of Pitt reserves all rights to fund fully, partially, or none of the external agency requests. 

   Pitt County Board of Commissioners - Goals for FY 2025-26

   - To promote quality education;
   - To promote community safety through enhanced emergency service programs;
   - To enrich the quality of life for Pitt County citizens through opportunities for improved health, welfare, and environmental concerns;
   - To address the facility and space needs of all county government programs—general government, public schools and community college;
   - To promote the provision of and access to recreational activities for county citizens;
   - To advance economic development opportunities for Pitt County; 
   - To champion infrastructure improvements throughout the county.

6. Agency Name*
8. Agency Director*
9. Phone Number*
11. Email Address*
13. Agency Mailing Address*
15. Amount of County Funding Appropriated in Current Year*
16. Amount of County Funding Appropriated in Following Year*
18. What Does Your Agency Do and Who Receives Services?*
20. Why are Pitt County funds being requested, and for what programs/efforts will funds allocated be used? How does this program/effort contribute to your long-range plans for recreation?*
22. What County goals does your program advance? (see instructions for clarification)*
24. What is the geographic service area of your agency?*
26. What other area agencies provide the services you provide for the residents of Pitt County?*
28. List any of your agency's sponsors and/or affiliated agencies.*
30. Does your agency contract with any agency of the County of Pitt (yes or no) or the State of NC (yes or no) for the provision of services?*

    1. Yes
    2. No
31. If yes, list services provided and with what level of government.
33. Is your agency Licensed or Certified by the State of North Carolina?*

    1. Yes
    2. No
34. Is your agency Chartered as a nonprofit corporation by the State of NC?*

    1. Yes
    2. No
35. Is your agency Certified by the Federal Government as a tax-exempt organization Under 26 USC 501© (3)?*

    1. Yes
    2. No
37. How is your agency governed and managed?*
38. Please attach a list of your Board of Directors, an organizational chart, and a copy of your agency's by-laws.*
40. Is your agency accountable to a governmental agency?*

    1. Yes
    2. No
41. If yes, which agencies?
43. If the County of Pitt has previously funded your agency, indicate the percent of your total annual budget represented by County Funding:
44. Fiscal Year Pitt County funded your agency:
46. What percent of your proposed 2025-26 budget would the County of Pitt requested funds represent? *
47. Does your agency have a detailed budget, which controls and guides the use of funds?*

    1. Yes
    2. No
48. Does a licensed CPA perform an annual audit for all funds handled by your agency?*

    1. Yes
    2. No
50. Form Completed By:
52. Name*
53. Title*
55. Phone Number*
56. Email Address*
58. Date Completed*
60. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
62. Electronic Signature
Leave This Blank:


64. Submit Submit and Print

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