Urban Affairs Coalition Services Application
Please use this form if you are interested in leveraging UAC's non-profit business services for your existing or planned organization
1. Tell us about your organization
Name of Organization
Mission Statement
Describe your Programming
Upload any program materials you have
What is your geographic reach?
Describe the demographics of those the organization serves
What is the biggest challenge your organization is currently facing?
Why are you seeking Fiscal Sponsorship?
What stage is your organization currently?
Just an Idea
We have a solid business plan
Incorporated as a LLC or another for-profit model
Incorporated with the State as a Nonprofit, but we don't have 501c3 status
Simple Pilot - we are not incorporated, but we have done some programming
We have our 501c3 status
We are Fiscally Sponsored by another organization
Website
This address is a (check all that apply)
Main Office
Home Office
One of several of the Organization's locations
Street Address
City
State
Zip Code
2. Tell us about you and your team
Your Title
Your First Name
Your Last Name
Your Phone Number
Your Email
Upload your Resume
Your LinkedIn Profile
How many hours a week can you commit to your organization?
Number of Advisory Board Members
The LinkedIn Profiles of your Advisory Board Members
Please Upload your Advisory Board Bios
Number of Full Time Employees
Number of Part Time Employees
Number of Volunteers
3. Tell us about your Organization's Financial Position
We have raised some funding
Yes
No
We have a bank account
Yes
No
We have audited financial documents
Yes
No
Our Annual Budget ( estimates are ok)
Total cash in-hand
Total Committed Funding
Total Contract Revenue
Upload your most recent 990, Audit or Financial Statement
Describe your Fundraising Strategy
4. For Insurance Purposes, please answer the following
How does your organization pay for its operating space
The Organization owns the office space
Private Residence / Home Office
Rent
Free
We don't have office space yet
The Office is built with
Brick
Wood
Not Sure
If you have space, what is the total square footage?
What is the total value of the Organization's office (furniture, computers, equipment, etc.)
What is the total value of the Organization's computer equipment?
Do your employees use vehicles on the job?
Yes
No
The vehicles are?
Employee-Owned
Organization-Owned
Rented as needed
If rented, how often?
Daily
A few times a week
A few times a month
Rarely (less then 10 times a year
Contact Information