Complete InteGrant's Client Intake Form Organization's legal name: * Additional doing business as (dba) or trade names: Is your organization a nonprofit? * (Please select one) Yes No Is your organization a non-profit or public tax-exempt organization as defined under Section 501(c)(3) of the Internal Revenue Code? (select one) * Yes, we are a registered 501(c)(3) No, but we are registered with our state If yes, what is your Federal Tax ID number (EIN):? State Business Identification Number * (UBI in Washington) Federal Unique Entity Identifier (UEI) if known: (Assigned by Sam.gov) Sam.gov renewal date, if known: MM DD YYYY Date organization was incorporated: MM DD YYYY Please provide a link to your organizations website: A website is not required. http:// Primary contact person for grant applications: * (first and last name) First Name Last Name Primary contact’s title/role with organization: * Primary contact’s phone number: * (###) ### #### Primary contact’s email address: * Organization’s physical address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Organization’s mailing address: * County/ies served by your organization: * Key details about the population(s) served by your organization: * Please tell us as much as you can in the space provided... What services is your organization interested in? Grant writing & editing services Fund prospecting (identifying funding sources) Grant reviews & resubmissions RFP writing & grantmaking Grant reporting Donor/fund development Contract writing and bid preparation Post-award assistance Other If other was checked above, please describe: (sponsorships, capital campaigns, annual pledges, etc.) What is your organization’s annual operating budget? * ($ USD) $ What is your organization’s current source(s) of revenue? * What is your organization’s annual grant wrting/fundraising budget? * $ What is your organization’s mission statement? * What do you intend to accomplish with grant writing/what are you seeking to fund? * Do you have a specific funding opportunity in mind? * (select one) Yes No Has your organization ever been awarded a state or federal grant? * (select one) Yes No Has your organization ever undergone an audit (financial or programmatic?) (select one) Yes No If yes, what year was the audit completed and were there any findings? How did you hear about us? * (select all that apply) Web Search (Google, etc.) Referral Social Media Other Thank you! One of our team will contact you within the next week for next steps.
