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* 1. Name of Organization

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* 2. Which of the following counties does your organization serve? Check all that apply.

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* 3. How many people will be served by your organization through the General Operating grant?

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* 4. Describe the racial makeup of the individuals your organization serves each year (approximate percentages):

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* 5. What approximate percentage of the population served is Hispanic or Latino/a/e/x?

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* 6. What is the gender identity of individuals served by your organization annually? (approximate percentages)

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* 7. What approximate percentage of the population served is transgender?

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* 8. What primary population does your program serve?

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* 9. What percentage of those served by your agency or this initiative would be considered of low-to-moderate income?

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* 10. Which of WOMEN’S WAY’s four pillars does your organization’s programming address? (Check all that apply.)

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* 11. Is the organization led by (Executive Director or Board Chair) a woman of color?

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* 12. Were your organization's last fiscal year revenues under $500,000?

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* 13. What were your organization's revenues for the last fiscal year? Please omit symbols like commas and dollar signs in your response.

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* 14. What were your organization's expenses for the last fiscal year? Please omit symbols like commas and dollar signs in your response.

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* 15. What were the sources of revenue (dollar amount)? Please omit symbols like commas and dollar signs in your response.

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* 16. If you would like to make any clarifications or comments on the above answers, please do so here.

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