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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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 Are you a national organization? Yes No Is this a governing board? Yes No Cause Mission Statement Programs Board Information & ExpectationsNumber of Current Board Members Maximum number of Board Members allowed per your By-Laws Board Composition Term Length Financial Gift Requirements Meeting & LocationsWhere do you meet and how often? Program Participation When do you have your Board Retreat? Director & Offices (D & O) Insurance in Place? Yes No Board Expectation LetterMax. file size: 256 MB.Board Application FormMax. file size: 256 MB.Process For Getting On Board Potential 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)
