ABOUT YOUR ORGANIZATION Organization Name: * Website / URL: Organization Email: * Organization Phone: * Employer Identification Number Do you think you'll generate more than $50,000 in any of the next 3 years? Yes No I am not sure Does this organization have assets that exceed $250,000 fair market value? Yes No I am not sure Are you applying for reinstatement of a previously revoked 501(c)(3) organization? Yes No I am not sure ORGANIZATION STRUCTURE How is your organization structured? Nonprofit Corporation Nonprofit LLC For Profit Corporation or LLC Unincorporated Association Trust I do not have a legal structure yet REGISTERED AGENT Registered Agent's Address (must be a physical address location; no P.O. Box). * Registered Agent Phone Number: * Registered Agent's Email Address * Board Chair's Name * Board Chair's Email Address. * Board Treasurer's Name * Board Treasurer's Email Address * Secretary's Name * Secretary's Email Address * If you have more than 3 Board members, please list each additional Board member's name, title, and email address: Do you intend to compensate Board members? * Yes No I am not sure ORGANIZATION ACTIVITIES To qualify for exemption as a section 501(c)(3) organization, you must be organized and operated exclusively to further one or more of the following purposes. Which of the following "purposes" apply to your organization? Organization's mission statement (under 20 words): Organization's most significant activities:
List the services that you will provide to the public. A service is something that you "do" - for example: feed the hungry, provide housing or shelter, tutor children, rescue animals, etc.
Will your organization conduct activities outside of the United States? Yes No I am not sure Will your organization provide disaster relief? Yes No I am not sure Will your organization provide grants or assistance to individuals or other organizations? Yes No I am not sure Briefly describe how your organization plans generate income to sustain its activities. Foundation Classification Will this organization be established as a Public Charity or Private Foundation? Public Charities generate a substantial amount of its income to further its mission from public sources (grants, donations, contributions from the public or government). Whereas, private foundations substantially obtain their income from private sources (such as an individual, family or company), and these organizations support the work of public charities. * Public Charity Private Foundation I am not sure Additional Information Please use the space below to share additional information or to ask a pressing question about the application process. Thank you for completing this questionnaire. Your responses will guide our understanding of your organization and areas where we can offer you support. Unless otherwise promised, please allow 1-2 business days for us to properly review your responses and contact you with next steps. I certify that the information provided is true based on my understanding. Yes, the information I have provided is true.