NON-PROFIT QUESTIONNAIRE

Part One

1. Name of Organization ____________________________________________________

2. Physical Address _________________________________________________________
City, State ________________________________________ Zip ___________________
3. Mailing Address __________________________________________________________
City, State ________________________________________ Zip ___________________

4. Phone ___________________ Fax _____________________ Other ________________

5. Web Address ____________________________________________________________
6. Current Social Media Presence: Facebook LinkedIn Twitter Instagram
7. Email Address ___________________________________________________________
8. Date Organization Incorporated __________________ IRS Status __________________
9. Purpose:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
10. Mission:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

1|Page

________________________________________________________________________
________________________________________________________________________
11. Name of Officials
A. Top Volunteer officer/Title:
_____________________________________________________________________
Place of Employment/Title:
_____________________________________________________________________
B. Executive Director/Title:
_____________________________________________________________________
C. Financial Officer/Title:
_____________________________________________________________________
D. Accountant/Who prepares audit/financial statements:
Name _______________________________________________________________
Firm ______________________________________ Phone ____________________

Part Two

Staff & Governance

1. Do you have the following governance documents in place?
a. Corporate filings and registration active and in compliance with Secretary of
State: ___________________________Yes No
b. Articles: ________________________Yes No
c. Bylaws: _________________________Yes No
d. Conflict of Interest Policy: __________Yes No
e. Committee Charters if any: _________ Yes No
f. Code of Ethics: ___________________Yes No
g. Board Member Agreements: ________Yes No

2|Page

2. Does Organization have a board policy of assessing, at least annually, the organizations
performance and effectiveness and of determining future actions required to achieve its
mission? Yes No
3. List of current Board of Directors with corporate affiliations:
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

____________________________
____________________________
____________________________
____________________________
____________________________

4. List of current staff members and role:

___________________________________
___________________________________
___________________________________

____________________________
____________________________
____________________________

5. Board meeting dates and attendance for past 12 months:

________________________________________________________________________
________________________________________________________________________
6. Date of last audited financial statements and IRS 990 filing:
________________________________________________________________________
7. Current fiscal year budget (board-approved): ___________________________________
8. Total revenue for past 12 months: ____________________________________________
9. Total expenses for past 12 months: ___________________________________________

Part Three
Programs in the Organization
Does Organization have any fundraising contracts/agreements in place?
Yes No

3|Page

What is Organizations fundraising methods:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

What is Organizations major programs and sector of operation (See attached list for sector of
operation categories, simply identify program with sector number):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Explain social problem Organization seeks to address (symptoms and systemic causes):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What is Organizations solution?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What socio economic impact does your program have on your target population/geography?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

How much money does your program need? _________________________________________

Desired type of capital (grant, loan, PRI): ____________________________________________

4|Page

How will investing in your Organization give a grantmaker visibility? What steps will the
Organization take to get them press or a ROI?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

5|Page

Sector of Operation Categories

I. Arts, Culture, and Humanities
II. Education
III. Environment, Animals
a.
Environmental Quality, Protection & Beautification
b.
Animal Related
IV. Health
a.
Health - General & Rehabilitative Services
b.
Mental Health, Crisis Intervention
c.
Health - Multipurpose Associations/Services Associated with Specific
Diseases/Disorders/Medical Disciplines
d.
Medical Research
V. Human Services
a.
Public Protection: Crime & Delinquency Prevention, Legal Administration, Legal
Services
b.
Employment/Jobs
c.
Food, Nutrition, Agriculture
d.
Housing/Shelter
e.
Public Safety, Disaster Preparedness & Relief
f.
Recreation, Leisure, Sports, Athletics
g.
Youth Development
h.
Human Services: Multipurpose & Other
VI. International/Foreign Affairs
VII. Public/Society Benefit
a.
Civil Rights, Social Action, Advocacy
b.
Community Improvement/Capacity Building
c.
Philanthropy, Voluntarism, and Grantmaking Foundations
d.
Science and Technology Research Institutes/Services
e.
Social Science Research Institutes/Services
f.
Public/Society Benefit: Multipurpose & Other
VIII. Religion
IX. Miscellaneous Mutual/Membership Benefit Organizations

6|Page