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100 Women Who Care - Chicago Chapter
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Charity Pre-Qualification Form
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Indicates required field
Name of Organization
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Name of Contact Person
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First
Last
Email of Contact Person
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Web URL
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Please provide your 501(c)(3) Tax ID number below
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Date Organization was Founded/Started
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Mission Statement
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Annual Operating Budget
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% of Operating Budget utilized for programs, mission, projects (non-administrative or overhead)
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# of people your organization serves and describe the target population
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Provide a brief explanation of how the 100 Women donation funds may be utilized (general fund, specific program, projects, equipment, materials, etc.)
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Current source of funding for organization
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% of funds that go to third party fundraisers
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What % of your funds are allocated to providing services within the Chicago city limits, EXCLUDING Chicagoland suburbs?
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0%
1-25%
26-50%
51%-75%
76%-100%
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?
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YES
NO
Do you agree NOT to create, sell or distribute a list with our members' contact information?
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YES
NO
Do you agree NOT to solicit our members directly for further contributions?
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YES
NO
Submit