Non Profit - Pre-Application Survey Organization’s Legal Name(Required)Contact Name(Required) First Last Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Address(Required) Enter Email Confirm Email Website Address Is Applicant a tax-exempt nonprofit organization under the U.S. Internal Revenue Code 501(c)(3)? Yes No FEINPlease provide a description of your organization’s operations (including programs and services offered and number of clients served by each program)Has your organization been in operation for less than 3 years? Yes No Annual BudgetAnnual RevenueAnnual PayrollNumber of EmployeesNumber of VolunteersDoes the Applicant's business operations include a physical premise or building? Yes No If yes, provide complete address and square footage of spaceDoes your organization host, sponsor, or co-sponsor any special events? Yes No Does your organization’s operations include any animal related programs or services? Yes No Does your organization’s operations include any residential or overnight programs or services? Yes No Do any of your employees or volunteers use their personal autos on behalf of your organization? Yes No Does your organization employ, contract or utilize volunteer professionals? Yes No Does your organization currently have General Liability coverage? Yes No Does your organization’s current insurance program include Sexual Misconduct and Molestation Coverage? Yes No Do you conduct criminal background checks on each prospective employee and volunteer, especially those working with children? Yes No N/A Please add any additional remarks that you would like for us to consider(Required)
