California State Employees Charitable Campaign Applications

The following applications may be filled out using Adobe Reader (version 4.0 or later) or may be completed by hand. To download the free Adobe Reader, please click here.

Please note that all applications require an original, ink signature.

Organizations that were approved for participation in 2009 will be mailed a 2010 application beginning November 2, 2009. All other organization will need to complete and submit the appropriate application, when available, below. Please call 916.491.3726 for questions regarding the CSECC application process.

• 2010 Non-Affiliate Instructions and Application - Filing Deadline February 1, 2010
• 2010 Affiliate Instructions and Application - Filing Deadline March 1, 2010
• 2010 Principal Combined Fund Drive Agency Instructions and Application - Filing Deadline March 1, 2010

If the date for filing the 2010 Application has passed and your organization wishes to participate in CSECC next year, please submit the following information via e-mail to CSECC@vcgcb.ca.gov in order to be added to the mailing list for the following year:

1. Name of Agency as recognized by the Internal Revenue Service as tax exempt under Title 26, U.S. Code, § 501(c)(3). (If the names do not match the name referenced on the I.R.S exempt letter, please include a letter from the I.R.S. or other state issued documentation authorizing any legal name change).
2. Mailing and physical addresses
3. Copy of the organization's I.R.S. 501(c)(3) designation, if necessary include a letter from the IRS or other state issued documentation authorizing any legal name change.
4. If your organization is represented (i.e. represented by a PCFD, United Way, Federation, etc.), please include the name of that organization and its contact information.
5. Names of the counties in which you will solicit funds or "statewide".
6. For PCFDs only, please indicate:
   1. The counties in which you operate (please specify the geographic boundaries of your area, if it does not encompass an entire county).
   2. Expenses: indicate the estimated percentage of annual contributions spent for fundraising and administrative costs.
   3. The approximate number of organizations your agency will be or is representing for the purposes of CSECC.

Updated: November 18, 2009