Interest Form Question Title * 1. Organization Name Question Title * 2. If selected to be a part of this cohort, who will be the organization's point of contact? Please provide the person's name and contact information. Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. Has your organization received its ruling from the Internal Revenue System (IRS) confirming its exemption from the federal income tax under section 501 (C) (3) of the Internal Revenue Code? Yes No Question Title * 4. What is the organization's annual budget? Question Title * 5. Does at least 25% of the organization's leadership (as you define it) or Board identify as Black, Indigenous, People of Color, LGBTQ+, or persons with disability? Yes No Not Sure Question Title * 6. What region does the organization serve? Miami-Dade Palm Beach (Palm Beach, St. Lucie, Martin) Tampa Bay (Hillsborough and/or Pinellas) Question Title * 7. To be considered for funding, at least 50% of the organization's population served must fall within the marginalized group(s) identified. Select the group(s) for which the organization provides programs/services. BIPOC (Black, Indigenous, and/or People of Color) LGBTQ+ Persons with disabilities Question Title * 8. What are the organization's overall goals related to increasing capacity? Question Title * 9. Does the organization have dedicated staff to commit to one year of nonprofit coaching and peer-to-peer learning virtually? Yes No Other (please specify) Question Title * 10. What does the organization hope to gain from this experience if selected? Done
