Preliminary Application

Fields marked with an * are required

Organization Name *

Address *

City *

US States *

Zip *

Website

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Primary Contact *

Email *

Phone *

Address (if different than above)

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1. Using fifty (50) words or less, state the purpose and aims upon which your organization was founded and is currently guided. *

2. Does the organization have a leadership team/leadership board and if so, how large (actual numbers, please) is the membership of this group? *

3. What kind of process does the organization employ for decision making, and where does final authority for decision making reside? *

Organization's Annual Budget *

Primary Funding Sources *