Please enter all of the following information.
Organization:
Physical Address:
Mailing Address (if different from
above):
Phone:
Fax:
Email:
Website:
Mission:
Scope:
Local
State
National
International
IRS Classification:
501(c)(3)
501(c)(6)
Other
(if Other, please specify)
Number of Employees:
Full Time:
Part Time:
Volunteers:
Organization type:
Arts
Educational
Environmental
Government
Human Services
Individual
Religious
Scientific
Sports
Youth/Recreation
Other
(if Other, please specify)
Operating Budget
$0 - $50,000
$50,001 - $100,000
$100,001 - $400,000
$401,000 - $1,000,000
$1,000,001 - $3,000,000
$3,000,000 - $5,000,000
$5,000,001 - $10,000,000
> $10,000,001
Individual completing this form:
Name:
Phone:
Email:
Title:
Description of assistance needed:
How did you learn about FRESC?