Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main Office Phone *

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Main Office Fax

(###)

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Name of Top Paid Staff

First Name

Last Name

Office Phone *

(###)

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Secondary Point of Contact *

Please provide the name of at least one additional team member responsible for supplying grant information

First Name

Last Name

Mobile Phone *

A mobile number is required in the event grant information is needed to meet a deadline. Mobile contact will only be used in the event email contact is unsuccessful.

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Has your organization conducted a S.W.O.T. Analysis or Environmental scan? *

Yes

No

Financial Analysis *

In order to provide your organization with financial analysis, certain documents must be submitted. Please place a checkmark next to a min of 3 items below that you will be able to provide within 24 hours of form submission.

IRS 990's (1-3 years)

Chart of Accounts

Income Statement (1-3 years)

Balance Sheet (1-3 years)

Cash Flow Statement (1-3 years)

Are you familiar with the term Logic Model?

Yes

No

Has your organization developed a Master Grant? *

Yes

No

Which scheduling days work best for your schedule? Check all that apply. *

Our firm operates Monday-Thursdays with Zoom Calls and Virtual training held on Tuesday & Thursdays between the hours of 9:00am-4:00pm

Monday

Tuesday

Wednesday

Thursday

Dose your organization have a General Liability and D&O Insurance Policies in place? *

Yes

No

Document Requirement Acknowledgement *

In the event our firm decides to accept you as a registered client, the following typical grant-related and organizational assessment documents must be submitted within 48 hours of completing your online registration. You will receive an email with an upload link to a private Google Drive folder set up for your organization. Documents can also be emailed, but upload is preferred. Email Documents to: socialarchitectllc912@gmail.com Copy of IRS 501(c)(3) Determination Letter Copy of any submitted grants W9 Form Signed by Authorized Representative Copy of Most Recent 990 Tax Return Company Non-Discrimination Policy State Incorporation Document State Nonprofit Registration (if applicable) 1-Page Organizational Budget 1-Page Program/Project Budget Organizations Logo jpg/png Most recent Financial Statement (Audited if Available) -Must include actual expenses. Statements should include a Balance Sheet, Statement of Activities, and Functional Expenses List of Board Members with Contact Information and Affiliations -Example: Jane Doe, Board Chair-Vice President, Wells Fargo Bank, 1129 Main St., Anytown, USA, 99988, PH: 912-009-8766, Email: JDoe@wellsfargo.net

Yes, I will submit the documents

No, I am unable to submit the documents