Not for Profit Incorporation Questionnaire

1. Organization

Name of Organization(Required)

Office Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

2. Contact

Contact Person(Required)

First Last

Contact Person Title(Required)

Contact Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Phone(Required)

Alternate Phone

3. Additional Contact

Who else may be contacted for additional information?

Please enter Name and Title/Position

Contact Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Phone(Required)

Alternate Phone

4. Additional Organization Information

Existing Organization

Yes

If so, how long?

Is the organization incorporated?

Yes

(Please attach copies of articles of incorporation and by-laws)

If so, in which State and date

Articles of Incorporation and By-laws Upload

Drop files here or

Max. file size: 50 MB.

(Please attach copies of articles of incorporation and by-laws)

Officers/Directors of the Organization

Drop files here or

Max. file size: 50 MB.

Please attach a list of all officers and directors, with addresses and phone numbers.

Tax exemption number

(Attach IRS Determination Letter)

Max. file size: 50 MB.

Budget for current year

Budget for last year

Please attach a copy of your income and expenses budget for the current year

Max. file size: 50 MB.

Does your organization have a fiscal agent?

Yes

If yes, Please fill out below.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

PART I: GENERAL INFORMATION

In answering the following questions, use additional sheets where necessary. Please attach any appropriate materials, sample grant proposals, brochures, flyers or similar materials describing your goals and activities.

Mission Statement

Describe in detail the programs, projects and services that are or will be offered by the organization.

GENERAL INFORMATION UPLOAD

Drop files here or

Max. file size: 50 MB.

PART II: LEGAL ISSUES

Describe in detail the type of legal assistance the group is seeking.

Have you consulted a lawyer concerning this?

Yes

If yes, please list the name(s) and why you are not pursuing this matter with the lawyer consulted:

Did you pay for the above-described services?

Yes

How did you hear of this Pro Bono Program?

I hereby affirm that the above information is true and correct to the best of my knowledge. The answers to this questionnaire describe the matter(s) for which my organization is requesting free legal assistance. I understand the project cannot guarantee a referral or the successful resolution of our legal problem. IT IS OUR ORGANIZATION'S RESPONSIBILITY & NOT THE RESPONSIBILITY OF THE PRO BONO PROJECT OR VL, TO PAY FOR ANY COSTS INVOLVED, SUCH AS FILING FEES WITH THE SECRETARY OF STATE. I agree to notify the project promptly if we do not wish to continue receiving legal assistance or of any other change in circumstances. I further acknowledge that the project does not represent the organization & takes no responsibility for our case.

Signature and Title(Required)

Date

Not for Profit Incorporation Questionnaire

GROUP CLIENT APPLICATIONQUESTIONNAIRE & FINANCIAL INFORMATIONFOR PRO BONO LEGAL ASSISTANCE

1. Organization

2. Contact

3. Additional Contact

4. Additional Organization Information

PART I: GENERAL INFORMATION

PART II: LEGAL ISSUES

GROUP CLIENT APPLICATION
QUESTIONNAIRE & FINANCIAL INFORMATION
FOR PRO BONO LEGAL ASSISTANCE