Wufoo

Organization Name *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Person * First Last
Contact Title *
Contact Email *
Contact Phone Number * ### - ### - ####
Website Address (if any)
Mission Statement *

Please tell us the mission statement of your organization.
Annual Budget *

What is your organization's annual budget for this fiscal year?
Percent of Board Members Giving *
Enter a number between 0 and 100.

What percentage of your board members have made a financial contribution in the most recent fiscal year?
Number of FTE Paid Staff *

Full Time Equivalents (FTEs). For example, four Part Time staff equals two FTEs.
Number of Volunteers who have worked 5+ hours with your organization in the last year *
County *

What county is your organization located in? (If you have multiple offices, please list the county where your organization is headquartered.)
What year was your organization founded? *
Enter a number between 4 and 4.

Example: 1974
What percent of your budget is allocated to programs? *
Enter a number between 0 and 100.

This percentage should not include administrative or fundraising expenses.
Please list your board members, the city they are from, and professional role.

For example:
John Smith
Fountain Inn, SC
President of ABC Company

Mary Poinsett
Greenville, SC
Teacher at Main Street Elementary
Please list all key staff and title. *

For example:
Jane Smith
Executive Director

Keith Jones
Program Coordinator
How will your organization use this grant to benefit the mission of the organization? *
Maximum Allowed: 1000 words. Currently Used: 0 words.
How will Engenius be recognized for this grant? *
Maximum Allowed: 500 words. Currently Used: 0 words.
How does your organization currently use social media? *
Maximum Allowed: 500 words. Currently Used: 0 words.

If your organization does not use social media - don't fret. Just indicate so here.
Why should Engenius choose your organization to receive this grant? *
Maximum Allowed: 500 words. Currently Used: 0 words.
Attach a PDF of your 501(c)(3) letter *
Attach a PDF of your most recent IRS 990 form *
Attach a copy of your current fiscal year budget *
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