DIRECTORY OF NONPROFIT ORGANIZATIONS:
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Organization Questionnaire
1. Name of Organization:
Alternate names for your agency (nickname, acronym, previous names):
Address:
City:
State: Michigan
Zip:
County:
Phone:
Fax:
Organization's e-mail address:
Organization's Web site address:
Year organization established:
Organization's current status:
Active Dissolved
Inactive, but not dissolved Considered dissolved because annual reports have not been filed in two years
2. Contact Person
First Name:
Last Name:
Phone:
Fax:
Contact's e-mail address:
3. Executive Director
First Name:
Last Name:
Executive Director since (month/year):
4. Board Chair
First Name:
Last Name:
Chair since (month/year):
Other Organization Information
5. IRS Designation:
501(c)(3)
501(c)(3) pending
Sponsored by another 501(c)(3)
  Name:      
Other    Please specify:      
6. Is your organization affiliated with a state/national/international parent organization?
No
Yes   Name:      
7. Your organization's mission statement:
8. Please give a brief summary of your organization's services and/or special programs:
9. How many people currently serve on your board of directors?
How often does your board meet?
10. How many people in your organization are full-time paid employees?
How many people in your organization are part-time paid employees?
These part-time employees are equivalent to how many full time equivalents (FTEs)?
11. What is the primary service area of your organization?
Washtenaw County National
Southeastern Michigan/Regional International
State of Michigan Other      Please specify:
       
12. Check those populations served by your organization (check all that apply):
Entire population Low income
Adults Men
Animals Mentally ill
Children/Youth Seniors
Disabled Students
Ethnic groups Substance abusers
Ex offenders Unemployed
Families Veterans
Gay/Lesbian/Bisexual/Transgender Victims/Survivors of domestic violence
Health related Women
Homeless Other      Please specify:
       
13. How would you classify the services provided by your organization? (check all that apply)
Arts, Culture and Humanities Recreation, Sports, Leisure
Education Athletics
Environmental Quality, Protection Youth Development
Animal-Related Human Services - Multipurpose
Health - General and Rehabilitative International and Foreign Affairs
Mental Health Civil Rights, Social Action
Diseases, Disorders, Medical Disciplines Advocacy
Medical Research Community Improvement
Human Services Capacity Building
Crime, Legal Related Philanthropy, Voluntarism
Employment, Job Related Grantmaking
Food, Nutrition Science and Technology
Agriculture Social Science
Housing, Shelter Multipurpose Public Benefit
Public Safety Religion Related
Disaster Preparedness and Relief Mutual/Membership Benefit
  Other    Please specify:
     
14. Which of these is your organization's primary focus?
Arts, Culture and Humanities Recreation, Sports, Leisure
Education Athletics
Environmental Quality, Protection Youth Development
Animal-Related Human Services - Multipurpose
Health - General and Rehabilitative International and Foreign Affairs
Mental Health Civil Rights, Social Action
Diseases, Disorders, Medical Disciplines Advocacy
Medical Research Community Improvement
Human Services Capacity Building
Crime, Legal Related Philanthropy, Voluntarism
Employment, Job Related Grantmaking
Food, Nutrition Science and Technology
Agriculture Social Science
Housing, Shelter Multipurpose Public Benefit
Public Safety Religion Related
Disaster Preparedness and Relief Mutual/Membership Benefit
  Other    Please specify:
     
15. Suggested key words to describe your organization and its services (for database search purposes; e.g., land preservation, runaways, museum, etc.):
16. Approximate annual operating budget of your nonprofit agency:
less than $50,000 $500,000 - $999,999
$50,000 - $99,999 $1,000,000 - $2,999,999
$100,000 - $249,999 $3,000,000 - $4,999,999
$250,000 - $499,999 over $5,000,000
17. How frequently do you use volunteers?
Daily Occasionally/special projects
Weekly Rarely
Monthly Not at all
Approximately how many hours of volunteer time are donated to your organization in a typical week?
18. Please add here any information, not previously included, that you would like the database users to know about your organization. If you have multiple programs and addresses, a referral to your web site is advised.
19. Wish List: Enter items your organization could use.