Client Intake Questionnaire

Company Representative Name *

Company Representative Phone *

Company Representative Email Address *

Company Name *

EIN#

Doing Business As

Phone

Website

Facebook Link

Instagram Link

Business Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Mailing Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Type of Company *Non-ProfitSole ProprietorLLCCorporation

Date Established *

Mission Statement

What Product Or Service Do You Offer?

Monthly Grant Services Budget?

How Many Months Are You Seeking Services For?

What Are You Seeking To Use Grant Funds For?

What Are You Hoping To Accomplish With Funding?

Google Drive Requirements

Please provide a google drive link including all pertinent documents that can assist me in properly reviewing your account:

Profit & Loss Statement for 2020 and 2021 (you can also include 2017-2019)
Projected Budget 2022
Board Members (including full name, board title, company name & job title, Month/Year range on board, responsibilities (no more than 5 sentences)
Executive and Program Staff (including full name, Job Title, Month/Year range with organization, responsibilities (no more than 5 sentences)
Business Plan
Letter of Inquiry
Brochure / Pamphlet
Newsletters (3 most recent)
Grant Applications (save file as name of foundation - grant name - month & Year submitted)
Recognitions & Awards (including grants received)
Top 10 Photos
Top 5 Videos
Program / Sponsorship Deck
IRS Determination Letter
Articles of Incorporation
IRS EIN Letter
Fictitious Business Name Paperwork

Please add dreamnorthent@gmail.com as an EDITOR

Google Drive Link

Describe The Organizational History

Describe The Key Team Members/Leadership

Who Are Your Target Beneficiaries?

If You Generate Revenue, What Is Your Model?

Define Your Relationship with Your Fiscal Sponsor. What Do They Add to Your Programming?

Relationships/Partnerships

How Did You Learn About Us?

If Referred, By Whom?

Please give us any important information or considerations not mentioned above here.

Project 1

Project Name

Amount Of Funding Sought

How Many Beneficiaries Will You Serve?

What Geographic Area Will You Serve?

List The Project Goals And Objectives

List The Outcome Measurement Strategies For The Project

Please Give Us Any Important Information or Considerations Not Mentioned Above Here.

Project 2

Project Name

Amount Of Funding Sought

How Many Beneficiaries Will You Serve?

What Geographic Area Will You Serve?

List The Project Goals And Objectives

List The Outcome Measurement Strategies For The Project

Please Give Us Any Important Information or Considerations Not Mentioned Above Here.

Project 3

Project Name

Amount Of Funding Sought

How Many Beneficiaries Will You Serve?

What Geographic Area Will You Serve?

List The Project Goals And Objectives

List The Outcome Measurement Strategies For The Project

Please Give Us Any Important Information or Considerations Not Mentioned Above Here.

Project 1

Project 2

Project 3

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