Charity PreQualification Form

Charity Pre-Qualification Form

* Indicates required field

Name of Organization *

Name of Contact Person *

First

Last

Email of Contact Person *

Web URL *

Please provide your 501(c)(3) Tax ID number below *

Date Organization was Founded/Started *

Mission Statement *

Annual Operating Budget *

% of Operating Budget utilized for programs, mission, projects (non-administrative or overhead) *

# of people your organization serves and describe the target population *

Provide a brief explanation of how the 100 Women donation funds may be utilized (general fund, specific program, projects, equipment, materials, etc.) *

Current source of funding for organization *

% of funds that go to third party fundraisers *

What % of your funds are allocated to providing services within the Chicago city limits, EXCLUDING Chicagoland suburbs? *

If you receive an award are you willing to send a representative to our next meeting to share how the money was, or will be, spent? *

YES NO

Do you agree NOT to create, sell or distribute a list with our members' contact information? *

YES NO

Do you agree NOT to solicit our members directly for further contributions? *

YES NO

Submit

Charity Pre-Qualification Form

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