FNC Emerging Partners Fiscal Sponsorship Initiative 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. Question Title * 1. Agency Name (if awaiting 501c3 determination or if you have a 501c3 status) (Required.) Question Title * 2. Project Name (Required.) Question Title * 3. Your Name (Required.) Question Title * 4. Your Title (Required.) Question Title * 5. Street Address (Required.) Question Title * 6. City, State, Zip Code (Required.) Question Title * 7. Mailing Address (if different than above) (Required.) Question Title * 8. City, State, Zip Code (Required.) Question Title * 9. Daytime Phone # (Required.) Question Title * 10. Cellular Phone # (Required.) Question Title * 11. Email Address (Required.) Question Title * 12. Project Website URL (if applicable) Question Title * 13. What is your mission statement? (Required.) Question Title * 14. 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? Yes, I agree to follow this policy without exception No, I do not agree with the policy. (If this answer is selected, you will not be considered for fiscal sponsorship). Question Title * 15. Describe the service (s) you provide/intend to provide (Required.) Question Title * 16. What are the demographics of the population you target/intend to target? (Required.) Question Title * 17. Please explain how you determined the need for this (these) service(s) (Required.) Question Title * 18. What other local/regional organizations have you identified who are doing similar work? (Required.) Question Title * 19. How will your services differ from those being offered by the organizations you mentioned in the previous response? (Required.) Question Title * 20. List 5 specific outcomes you expect to reach in the first year of your project (Required.) Question Title * 21. What activities will you engage in to achieve these goals (include information about who will be involved and where the activities will take place)? (Required.) Question Title * 22. Please describe your qualifications for carrying out this work (Required.) Question Title * 23. Do you currently have a Board of Directors or an advisory committee? (Required.) Yes No If yes, please list names and titles Question Title * 24. Do you currently have funding in place for this agency/project? (Required.) Yes No Pending If yes or pending, please list funder(s) and amount(s) (or expected amount(s)) Question Title * 25. Do you expect to have anyone on your payroll in the first year of operation? Yes No Question Title * 26. 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). Question Title * 27. What is your current 501c3 status? (Required.) Applied for 501c3 status Have not yet applied for 501c3 status Do not intend to apply for 501c3 status Currently have active 501c3 status in place Please explain your answer - include any dates of application, determination, etc. Question Title * 28. Has your project ever operated under a different name than it currently operates under? Yes No If yes, please list each name and the approximate dates that you operated under each name. Question Title * 29. Have you ever had a 501(c)3 that was revoked? Yes No If yes, please provide details, including why your 501(c)3 status was revoked, all names the 501(c)3 operated under, the year(s) of operation, and the address you used when in operation. Question Title * 30. What do you expect your total budget to be in year one? (Required.) Question Title * 31. Please explain why you are seeking a fiscal sponsor (Required.) 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 sustainabilityOnce this is in and approved, you will be invited in to discuss the proposed agreement and to complete paperwork. Question Title * 32. How did you hear about us? Fiscal Sponsor Directory A current fiscally sponsored project of FNC FNC website Facebook Other If you heard about us from a fiscally sponsored project of FNC, or if you listed "Other" as your response - please let us know specifically where you heard about us! 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) Done