Organizational Chart Nonprofit - DOC by mct20122


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									                                                             APPLICATION FORM
This form should be saved to your computer file before you complete it. You must complete it in full. Use the
TAB key to move around the document. The attachments you need to send with this form are: a separate full
proposal narrative (answering the 7 questions from the guidelines), most recent operating budget, most recent
financial statement, organizational chart (if used) and completed NH nonprofit checklist.


Applicant Organization Name:

EIN Number:                   Website URL: www.                      Phone Number: (         )-     -

Street Address or PO Box:                            City:                   State:     Zip Code:

CEO/Executive Director:                     Title:           email address:

Contact for Application (if different from above):                  Title:

Phone: (          )-           Email:


Year Founded:                 Number of Clients Served per year:                      Field of Service: None Selected

Geographic Area Served by Organization:

Number of Paid Staff:               (indicate in FTEs)          Annual Operating Budget: $

                                            You can cut & paste a word document into these fields

List of Board Members:

Organization Mission Statement (25 words or less):

Organization Description (100 words or less): (scope of work, highlight current programs and services):

Additional information you need to include with this application:
    Separate Full Proposal Narrative (answer questions 1-7 from The Corporate Fund Nonprofit Management Award Guidelines)
    Most recent operating budget
    Most recent financial statement
    Organizational chart, if used
    Completed NH Nonprofit Checklist

The Corporate Fund Award Form Page 1 of 2
Email your application form and attachments to or mail to NH Charitable Foundation, 37
Pleasant Street, Concord, NH 03301 by 5:00 pm August 1, 2010. Please be sure the subject of your email starts
with “The Corporate Fund Award” followed by organization name. For example: The Corporate Fund Award,
ABC Learning Center. Attach your form rather than copying it into the text of the email.

The Corporate Fund Award Form Page 2 of 2

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