Center for Nonprofit Excellence

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Login Information

1. User name
   
2. Password
   
3. Password confirmation
   

Organization Information

1. Organization name
   
2. Organization address
   
3. Organization city, state & zip
   
4. Organization phone
   
5. Organization fax
   
6. Website
   

Chief Staff Officer or Executive Director

1. Director name
   
2. Director phone
   
3. Director fax
   
4. Director email
   

Contact Person / Project Director

1. Contact name
   
2. Contact phone
   
3. Contact fax
   
4. Contact email
   

General Information

1. Year founded
   
2. Employer id number
   
3. Geographic area
   
4. People served annually
   
5. Mission statement
   

   Your response may contain 750 more characters.

6. Objectives, Methodology, and Most Recent Accomplishments of Organization
   

   Your response may contain 1750 more characters.

7. Is Organization listed as 'non-profit' with the Secretary of State?
   Yes No
8. Is Organization exempt under IRS 501(c)(3) guidelines (or earlier versions)?
   Yes No
9. Is Organization exempt under 509(a) guidelines (public charity)?
   Yes No
10. Affiliations
    

    Your response may contain 500 more characters.

Funding Information

1. Fiscal year begins
   January February March April May June July August September October November December
2. Fiscal year ends
   January February March April May June July August September October November December
3. Annual Operating Budget (current year)
   
4. Annual Operating Budget (previous year)
   
5. If the organization was the recipient of funding from the agencies below, please list.

   	Current Year		Previous Year
   Source	$ Amt.	% of Op. Budget	$ Amt.	% of Op. Budget
   United Way
   Federal Government
   State Government
   Local Government

6. Size and Source of 5 Largest Grants (other than the government and United Way grants above)
   

   Source	Current Year	Previous Year

Organization Personnel

1. Number of full-time Employees
   
2. Number of part-time Employees
   
3. Number of Volunteers
   
4. Number of Directors on Board
   

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