Nonprofit Intake Form Nonprofit Name*ContactsName* First Last Title*Mobile Phone*Work Phone*Email* Alternate Contact Name* First Last Title*Mobile Phone*Email* General Info About Your NonprofitWebsite*Nonprofit Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EIN Number*Tax Status ( i.e. 501 c 3 )*990 on file (GuideStar) Yes No CauseMission StatementProgramsBoard Information & ExpectationsNumber of Current Board MembersMaximum number of Board Members allowed per your By-LawsBoard CompositionTerm LengthFinancial Gift RequirementsMeeting & LocationsWhere do you meet and how often?Program ParticipationWhen do you have your Board Retreat?List of CommitteesDirector & Offices (D & O) Insurance in Place? Yes No Board Expectation LetterBoard Application FormProcess For Getting On BoardPotential Board MembersAttributes and Demographics of New Board MembersWhat is your nonprofit looking for in a new board member? (Demographics, skills, education, networks/connections) Attributes and Demographics of a Second New Board MembersIf your nonprofit is looking for a second board member, what attributes are you looking for in this new board member? Leave blank if you are only looking for one board member. (Demographics, skills, education, networks/connections)
