Thank you for your interest in FNC's Emerging Partners Fiscal Sponsorship Initiative. This is the fiscal sponsorship arm of our agency. Please carefully respond to the questions below. Once completed, please email Jerry Tapley, Executive Director, at jerryt@FNCphilly.org. Once your application has been reviewed, you will be contacted regarding next steps.
Agency Name (if awaiting 501c3 determination or if you have a 501c3 status)

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* 1. Agency Name (if awaiting 501c3 determination or if you have a 501c3 status)

Project Name

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* 2. Project Name

Your Name

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* 3. Your Name

Your Title

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* 4. Your Title

Street Address

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* 5. Street Address

City, State, Zip Code

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* 6. City, State, Zip Code

Mailing Address (if different than above)

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* 7. Mailing Address (if different than above)

City, State, Zip Code

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* 8. City, State, Zip Code

Daytime Phone #

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* 9. Daytime Phone #

Cellular Phone #

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* 10. Cellular Phone #

Email Address

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* 11. Email Address

Agency Website URL (if applicable)

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* 12. Agency Website URL (if applicable)

Project Website URL (if applicable)

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* 13. Project Website URL (if applicable)

What is your mission statement?

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* 14. What is your mission statement?

FNC requires that all fiscally sponsored projects adhere to our non-discrimination policy. Our policy is:
FNC   shall not discriminate on the basis of race, color, national origin, political affiliation or belief,
religion, ancestry, union membership, age, sex, sexual orientation or gender expression, marital status,
personal appearance, family responsibilities, matriculation, mental or physical challenge or any other
characteristic protected under federal, state or local law. If we mutually agree to move forward with a
fiscal sponsorship relationship, do you agree to follow this policy without exception?

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* 15. FNC requires that all fiscally sponsored projects adhere to our non-discrimination policy. Our policy is:
FNC   shall not discriminate on the basis of race, color, national origin, political affiliation or belief,
religion, ancestry, union membership, age, sex, sexual orientation or gender expression, marital status,
personal appearance, family responsibilities, matriculation, mental or physical challenge or any other
characteristic protected under federal, state or local law. If we mutually agree to move forward with a
fiscal sponsorship relationship, do you agree to follow this policy without exception?

Describe the service (s) you provide/intend to provide

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* 16. Describe the service (s) you provide/intend to provide

What are the demographics of the population you target/intend to target?

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* 17. What are the demographics of the population you target/intend to target?

Please explain how you determined the need for this (these) service(s)

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* 18. Please explain how you determined the need for this (these) service(s)

What other local/regional organizations have you identified who are doing similar work?

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* 19. What other local/regional organizations have you identified who are doing similar work?

How will your services differ from those being offered by the organizations you mentioned in the previous response?

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* 20. How will your services differ from those being offered by the organizations you mentioned in the previous response?

List 5 specific outcomes you expect to reach in the first year of your project

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* 21. List 5 specific outcomes you expect to reach in the first year of your project

What activities will you engage in to achieve these goals (include information about who will be involved and where the activities will take place)?

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* 22. What activities will you engage in to achieve these goals (include information about who will be involved and where the activities will take place)?

Please describe your qualifications for carrying out this work

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* 23. Please describe your qualifications for carrying out this work

Do you currently have a Board of Directors or an advisory committee?

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* 24. Do you currently have a Board of Directors or an advisory committee?

Do you currently have funding in place for this agency/project?

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* 25. Do you currently have funding in place for this agency/project?

Do you expect to have anyone on your payroll in the first year of operation?

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* 26. Do you expect to have anyone on your payroll in the first year of operation?

If you answered "yes" to question 26, please use the space below to let us know how many people you expect to be on payroll, whether the individuals will be full or part-time, and any other information that you may have. (Please note, we understand that you may not have this information at this time, but let us know what your goal is for this year regarding payroll/staffing).

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* 27. If you answered "yes" to question 26, please use the space below to let us know how many people you expect to be on payroll, whether the individuals will be full or part-time, and any other information that you may have. (Please note, we understand that you may not have this information at this time, but let us know what your goal is for this year regarding payroll/staffing).

What is your current 501c3 status?

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* 28. What is your current 501c3 status?

What do you expect your total budget to be in year one?

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* 29. What do you expect your total budget to be in year one?

Please explain why you are seeking a fiscal sponsor

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* 30. Please explain why you are seeking a fiscal sponsor

Once your application has been reviewed, you will be contacted. If you are invited as a partner in our Emerging Partners Fiscal Sponsorship Initiative, you will need to provide the following:

- A detailed description of your project
- Project goals and how you will measure success
- A budget for the first year of operation
- A plan for sustainability

Once this is in and approved, you will be invited in to discuss the proposed agreement and to complete paperwork.
For your information, here are some of the expectations for fiscal sponsorship partners through FNC's Emerging Partners Fiscal Sponsorship Initiative:
- All fiscal transactions for the project/agency must be channeled through FNC
- All income is received and all expenses are paid through FNC
- All partners must operate balanced budgets
- New contracts must be approved through FNC
- Partner employees fall under the policies and procedures of FNC
- Project/agency director meets quarterly with FNC management team (monthly during the first quarter of the partnership)

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