$MDC - Organizational Applicant - The Grantbuilder (tm)

$Million Dollar Challenge

Organizational Application

* Indicates required field

Name *

First

Last

Email *

1) What is your title and/or role with the organization? *

2) Legal name of the organization *

3) Check every box that applies to your organization: *

*Other: Specify type of tax-exempt organization and/or type of corporation *

4) Where is your organization located? (City and State) *

5) What is your organization's website address? *

6) Has your organization previously received grant funds? *

Yes No

If "Yes" use the box below to enter the following four items of info for each grant received:

Name of funding source
Amount of grant
Purpose of grant
Year(s) grant awarded

Comment *

7) How long has your organization been in existence? *

1 - 3 years 4 - 5 years 6+ years

8) How many board members does your organization have? *

9) Has your board established an annual contribution requirement for individual board members? Choose One *

Yes No

9a) If "yes" to the question above, indicate the type of requirement. Choose One: *

Give (from personal resources) Get (from outside resources) Give or Get (can be either or a combination of the two resources)

9b) If "Yes", what is the required amount per year? *

10) Indicate the month and day of the organization's fiscal year. *

11) How much is your organization's current annual budget? *

12) List and briefly describe the organization's main source(s) of funding. *

13) What is the last fiscal year an IRS Form 990 was filed? *

14) Place a check mark next to each financial statement that your organization has readily available. *

Balance Sheet for most recent month or quarter of this year Balance Sheet for most recent fiscal year Operating Statement/Income Statement for most recent month or quarter Operating Statement/Income Statement for most recent fiscal year

15) How many employees on payroll (W-2)? *

16) Does your organization have any current contractors/consultants? *

Yes No

17) What is the organization's Mission Statement? *

18) List and provide a brief description of the organization's main programs *

19) Total number of clients served annually? *

20) Total number of clients served so far this year? *

21) Key Partners and Collaborators:

Prepare a list of key partners, along with a brief description of their roles in collaboration with you. The list may include other nonprofits, publicly-funded entities like schools, museums, Parks & Recreation, churches and other faith-based organizations, businesses and elected/appointed public officials. *

22. Use the box below to enter any additional information you would like to share about your organization. *

You will receive an email with feedback on your application within 48 hours* (*or within 2 business days).

Submit