501(c)3 Formation Questionnaire

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* 1. Please provide all information for your organization.

Organization

Name of Founder

Address

Address 2

City/Town

State

Zip Code

Email Address

Phone Number

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* 2. What is the mission of your organization?

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* 3. Is the organization incorporated with your state?

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* 4. Have you obtained an Employer Identification Number (EIN) from the IRS?

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* 5. If you have obtained your EIN, please provide it below.

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* 6. Please provide names of at least 3 Board Members including their title. (You must have at least a President, Secretary, and Treasurer)

President

Vice-President

Secretary

Treasurer

Board Member

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* 7. Are any of the Board members related to one another?

Yes

No

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* 8. If yes, how are they related?

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* 9. Do you plan to raise more than $50,000 in EACH of the next 3 years?

Yes

No