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CAMP Public Service Application
Full Name of Organization:
Mailing Address:


Telephone Number:(       )
Contact Person:
When, where, and for what purpose was the organization formed?





Is the organization nonprofit? o Yes o No

Does the organization have a national headquarters?o Yes o No

What is the exempt status with the Internal Revenue Service?


What services does the organization offer and who are the recipients?





How is the organization funded?





If funds are solicited from the general public, is the organization registered with the National Information Bureau? o Yes o No                                          

If it is registered, does the Bureau state in its current report that your organization meets its standards? o Yes o No                                              

What is the nature of the problem that you believe can be alleviated with the help of public service advertising?   Please document the problem, using some key statistics or other evidence.






What will the individual, the “person on the street”, be asked to do in your advertisement?






When and in what media would you like to see your advertising appear?





In your opinion, to what extent, if any, would the proposed public service advertising campaign be: sectarian, politically partisan, commercial, or special interest of an influence upon pending legislation?










What other organization(s) private or federal, presently offer public service advertisements addressed to the same problem?   How does your program differ?





Have funds been allocated or budgeted with which to conduct the public service advertising campaign, and if so, what amount?





Have you made any arrangements for creation, production, reproduction, or distribution to the media?   Have you approached any other group or advertising agency to create advertising or related activities?   If yes, please provide the name of the group or agency.





When does your organization hope to launch your public service advertising campaign?





In addition to the answers requested above, please provide us with your most recent Annual Report.
If you would like more information about the public service campaign or wish to submit an application for your organization to be considered as a recipient of CAMP’s 2006-2007 multimedia award, please contact Public Service Chairperson John Cassidy at 843-602-8806 or by email at john@duplicatesink.com. Deadline for all applications is September 2, 2006.