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CHARITY APPLICATION FORM

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Page 1

Name of your organization:
Phone Number:
Mailing Address:
Email Address:
Web Site:
Please provide your organization's Employee Identification Number (EIN).
EIN:

Page 2


Please identify your organization's area of focus:(check all that apply)
	Education Economic Development Mental Health Nutritional Help Other (describe below)
Please describe your organization's mission.

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Page 3

Please describe your organization's programs. (Use this area to tell us about your organization's programs and initiatives, as well as who these programs serve.)

Please describe your organization's accomplishments and the results of your work in your community. Be as specific as possible. (Use this space to describe how your organization impacts your community. Please use statistics, geographical areas affected, number of people served, and any other information that may be relevant to describing the results of your organization's efforts.)

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Page 4

Please describe your organization's objectives moving forward -- what you hope to accomplish in the future. Be as specific as possible. (Please use statistics and figures to describe how your organization will help your community in the future -- the number of people will be served by your efforts, and how you plan on providing that service, for example.)

How long has your organization been in existence?

What geographical area does your organization serve? Please include city or county, state, and zip code.

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Page 5

Do you already have an evaluation system in place to measure the effectiveness of your programs? If so, please tell us about that system here. (If you don't have an evaluation system, it's OK!)

What is the range of your operating budget?

Please describe what services you need. ("Services" includes needs like administrative assistance, volunteers or employees for specific programs, vocational training, supplies, or any other physical or financial needs.)

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Page 6

Any contributions or grants you receive will go to the following: (check all that apply)
	Unrestricted expenses Specific programs Endowments Buildings Other (describe below)
Please list any and all keywords that describe your organization -- these terms will be used to allow donors to find your organization in our network.

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