NSP Financial Management Program Application 2020-2021 Survey

Name of Organization:(Required.)

The organization’s mission and primary constituency:(Required.)

Geographic area served by the organization. Please indicate the percentage of services provided in the Hartford Foundation’s 29-town region (www.hfpg.org/towns).(Required.)

Number of full-time and part-time staff:(Required.)

Workshop series participants (maximum of 5) and contact information:

Workshop Participant #1: (Executive Director)(Required.)

Name

Title

Address

Phone Number

Workshop Participant #2: (CFO/Finance Director)

Name

Title

Address

Phone Number

Workshop Participant #3: (Program and/or Development Director)(Required.)

Name

Title

Address

Phone Number

Workshop Participant #4: (Program and/or Development Director)

Name

Title

Address

Phone Number

Workshop Participant #5: (Board Member: Chair, Treasurer, Finance Committee Chair)(Required.)

Name

Title

Address

Phone Number

Size of current operating budget?(Required.)

What is your current financial staffing structure?(Required.)

Please explain why you wish to participate in this program and describe how you think it would be beneficial to your organization.(Required.)

Did your organization receive a PPP Loan in 2020?(Required.)

Yes

Does your organization have an established line of credit?(Required.)

Yes

How many Board members does your organization have?

Please provide a demographic breakdown of your organization's Board members:

African American/Black/Caribbean American

Asian American

Caucasian

Latino(a)/Hispanic

Native American

Other

I understand that the team identified above is committed to attending any required sessions of this training program in their entirety.(Required.)

Yes

Electronic signature and date:(Required.)

Additional information to be submitted with your application:

Most recent operating budget, with year-to-date actuals.
Audited financial statements for the three (3) most recent completed fiscal years. (Note: If your organization does not annually conduct an audit, you may substitute your form 990)

Required attachments should be emailed to Amy Studwell at astudwell@hfpg.org

Current Progress,

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