OOH Pre 501(c)3 Information Submission Client Questionnaire Please note that these are general questions that apply to most organizations. Depending on your organization’s specific activities, additional information may be necessary. Question Title * 1. 501(c)3 Contact Person Name Address City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 2. Have you chosen a name for your organization? YES NO Question Title * 3. Please give us a brief summary about the purpose of your organization. What are the programs you will be offering, and to whom? Please give specifics. Describe the Who, What, When, Where, and How for each planned activity. Question Title * 4. Have you Incorporated your Nonprofit? YES NO Question Title * 5. Does your organization have an EIN number? YES NO Do you want OOH to assist? Question Title * 6. What type of Nonprofit are you forming? Question Title * 7. Does your Nonprofit have a website? YES NO Would you like OOH to assist? Question Title * 8. Other Key Information Needed What is the corporation’s registered address? When does your fiscal year end? Question Title * 9. Has your organization ever received a state government grant, or not? Yes, it has No, it has not Not sure Question Title * 10. Has your organization visited and/or plans on visiting countries outside the United States? Yes No Not Sure Question Title * 11. Do you have a the Board of Director's (BoD) members bio or resume? If not, when will they be available? YES NO Availability Date: Question Title * 12. Have any of your board members, officers, or key employees previously been convicted of a crime, wither misdemeanor or felony? If yes, please explain in the comment box. YES NO Other (please specify) Question Title * 13. How will you make people aware of your organization and its programs? Question Title * 14. Will the organization purchase any goods or services from members of the board? If yes, please provide feedback in the comment block. YES NO Other (please specify) Question Title * 15. Do you plan to do any gaming or raffles? Yes No Question Title * 16. Will you have a paid staff? If so, please describe who, for what positions, and how much. Question Title * 17. How much do you believe your organization's income will be in: 2016 2017 2018 2019 Question Title * 18. Do you believe your Nonprofit will make more than $10,000 per year for any of the next 3 years? Yes No Question Title * 19. What specific expenses will the organization incur in operating these programs? Question Title * 20. How does your organization plan on raising funds? YES NO Email, Phone and Mail solicitations Email, Phone and Mail solicitations YES Email, Phone and Mail solicitations NO Government and community grants Government and community grants YES Government and community grants NO Website donations Website donations YES Website donations NO Community Fundraisers Community Fundraisers YES Community Fundraisers NO Personal solicitations/donations Personal solicitations/donations YES Personal solicitations/donations NO Other (please specify) Question Title * 21. Board of Director's (BoD) Chairperson Information Name Company Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number Question Title * 22. BoD Secretary Information Name Company Address City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 23. BoD Treasurer Information Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 24. BoD Member Name Company Address City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 25. BoD Membership Key Questions Will they receive pay? Fee or program requirements for BoD members? Any membership not on BoD who has voting rights? Are any of the board members related? How? BoD's total time and resources required? Done