New Client Questionnaire

Do you represent a business/organization?*
- Yes
- No, I am an individual and do not represent a business/organization.
Please describe the primary service you are seeking:
Are you seeking grant funding support?*
Organizational Information
Organization Name (Legal Name):*
Also Known As/Doing Business As
Website
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Organizational Background
Organizational Mission & History*
Tell us about your business/organization.*
Legal Status of Organization*

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Grant Funding Eligibility
To be considered for grant funding, please complete this section:
Federal Tax ID Number (EIN)
State Tax ID Number
Up-to-date Tax Filings?*
- Yes
- No
When do you anticipate completing any outstanding tax filings?
Date of Organizational start (Incorporation/Establishment)*

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Main Contact Person
Please provide the contact information for the person most knowledgeable with the project, goals, etc.
Name (Main Contact)*
First Last
Title
Email*
Enter Email Confirm Email
Phone*
Address is Same as Organizational Address?*
- Yes
- No
Main Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this person the contract signatory?*
- Yes
- No
Contract Signatory Name*
First Last
Title
Email
Enter Email Confirm Email
Phone*
Secondary Contact (if applicable)
Secondary Contact
First Last
Title
Phone
Email
Enter Email Confirm Email

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Description of the Project/Program (If you have multiple project/program ideas, please only include the top THREE below):
Description Project/Program #1*
Expected Outcomes of Project/Program #1 (who/what will benefit?)*
Please describe the main components of a grant budget (salaries, equipment, materials, etc.) and their associated approximate costs for Project/Program #1:*
Do you have a second and/or third project to consider for funding?*
- No, just one project
- Yes, a second project
- Yes, a second and third project
Project/Program #2
Description Project/Program #2*
Expected Outcomes of Project/Program #2 (who/what will benefit?)*
Please describe the main components of a grant budget (salaries, equipment, materials, etc.) and their associated approximate costs for Project/Program #2*
Project/Program #3
Description Project/Program #3*
Expected Outcomes of Project/Program #3 (who/what will benefit?)*
Please describe the main components of a grant budget (salaries, equipment, materials, etc.) and their associated approximate costs for Project/Program #3*

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GRANTS: Potential Funding Resources
Potential Project Partners-What other organizations can support your potential project? Collaboration and community involvement is very important, please think carefully about this item.*
Has your organization ever received any funding?*
- Yes
- No
Past/Current Sources Of Grant Funding:*
Percentage of your current operations are currently supported by grant funding:*
Is there anything further you would like GWC to consider when evaluating your funding eligibility?*
Would your organization like to be considered for (check all that apply--hold command to select more than one field):*
Please describe 'Other':*
Consulting Services
Please describe the service you are seeking.

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Additional Comments/questions.
Anything else we should know? Any initial questions that we could begin answering for you?
Additional comments/questions.

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Organizational Information