2021 Independent Certification Application


This application is for nonprofits looking to apply to be a part of the Our Promise Campaign listed as “Independent”. If you are already applying as part of a PCFD or Federation, please disregard this application.

Physical Address

No PO Box addresses are accepted in this field.

Mailing Address(If different than Physical Address)

PO Boxes are acceptable in this field.


Provide a 25-word statement describing your organization’s activities. Do not include the name of your organization, phone number, email or website in your statement. This information will already be included in your listing. Statements exceeding the 25-word maximum will be edited.

2021 Nonprofit Application: Independent organizations only
Conditions for Approval
By signing this application, the participating charitable organization agrees to the following conditions:

1) This digital application form must be complete and submitted no later than the February 26th, 2021 filing date. A timely submission is necessary to ensure that the organization will, if approved by the Department of General Services (DGS), be included by name in the 2021 Our Promise: California State Employees Giving at Work Initiative. 

2) If DGS or its designee requests information supporting a certification of eligibility, the information must be furnished within two business days. The burden of demonstrating eligibility shall rest with the applicant.

3) The administrative fee for the 2021 OP Initiative is as follows:

a) $.38 cent per transaction fee as set by the State Controller’s Office (SCO). This fee is subject to change.

b) 14% administrative  set rate:

  • 8% allocated to United Way California Capital Region (UWCCR) to manage and process the campaign year round
  • 5.5% for reimbursement to the local Principal Combined Fund Drive (PCFD) for fundraising expenses
  • .5% to DGS for related campaign activity reimbursement

This fee structure is subject to change. You will be informed of any changes made prior to the 2021 Our Promise Campaign.

c) The overall DGS approved percentage rate and SCO per transaction fee will be published in the 2021 OP Initiative literature distributed and on the website.

4) To hold harmless the State of California, including but not limited to its officers and employees, from any liability that may result from requesting, canceling or changing any payroll deduction, in consideration for and as a condition of the SCO withholding and transmitting payroll deductions, as authorized by California Government Code section 1151(f).

5) To immediately send notification by email to opcertification@uwccr.org of any changes to the information provided in or in connection with this application. Any changes to our application will be reviewed by the DGS designee to determine if we still comply with all applicable requirements.

6) DGS may elect to disqualify or remove an organization that makes a false certification and/or engages in illegal activity.

7) To retain a copy of this digitally signed application and produce it to DGS or its designee within two business days of request for the original application.

We certify under penalty of perjury that:

1) We are currently a charitable organization qualified as “exempt” under Section 23701d of the California Revenue and Taxation Code and paragraph (3) of subsection © of section 501 of the Internal Revenue Code of 1954 .

a) We are in compliance with the provisions of the California Fair Employment and Housing Act, Part 2.8 (commencing with Government Code section 12900).

b) Our organization, its Board Members and Executive Officers are not in violation of any State of California or federal laws and regulations.

c) We are a valid 501(c)(3) nonprofit organization and are in good standing with the Registry of Charitable Trusts to operate or to solicit for charitable purposes in California.  A status of “current” or “exempt active” is required. An unregistered charity or a registered charity that is delinquent, suspended or revoked is not in good standing. (Gov. Code, § 12599.6, subd. (f)(1); Cal. Code Regs., tit 11, §999.9.4.)  A charity that is not in compliance with the registration and reporting requirements listed above, will not be certified in the Our Promise: California State Employees Giving at Work Initiative.  

2) After careful review of the instructions, we have completed the application and to the best of our knowledge, all of the answers are true, correct and complete. By completing this application, we are requesting certification as a Independent Nonprofit in the OP initiative and do not want to be listed under a Charitable Federation or PCFD (aka local United Way). 

By typing your name in the box above, you are providing a digital signature that affirms the accuracy of the information provided within this application.