Organization Name*
Address*
City*
State*
Contact*
Title
Phone*
Fax
Email*
Website
Organization's Mission
Describe the purpose or mission of your organization.*
Please select that best applies.The organization serves primarily low-income individuals or communities. The organization's statement of purpose includes activities to benefit low-income, disadvantaged and/or distressed communities. The matter on which legal assistance is sought raises issues of significant legal consequence to low-income, disadvantaged and/or distressed communities. The organization serves another important public interest.
Which category best describes your organization?Arts and Culture Education Health Housing and Shelter Community Development/Organizing Social Services Other If other please specify:
Legal Project
Please describe in detail the type of legal assistance you are requesting.*
Do you need assistance starting a nonprofit?Yes No Yes No
Are there other individuals or organizations directly involved in the legal matter with which you are requesting assistance (e.g., other parties to a contract)?Yes No
About Your Organization
How many years has your organization existed?
Is your organization incorporated?Yes No
About how many people does your organization currently serve?
Where does it provide services?
What is the organization's annual budget (current or proposed)? $
Is there a line item for legal fees?Yes No If yes, how much? $
Please provide the name, phone number and affiliation of any lawyer who is now helping or has helped your organization or who sits on your organization's board of directors. Briefly describe the service provided and the dates of service during the last three (3) years. Please advise whether the services were provided pro bono.
If your organization paid standard legal fees for the project requested in this application, would such payment significantly deplete the organization's resources or otherwise be inappropriate?
Does your organization currently use a fiscal sponsor?If yes, please name organization:
How Did You Hear About Us?
Please tell us how you heard about CULI:Seminar Other Nonprofit Organization An Attorney Current or former CULI Client Internet Search Other Professional (accountants, consultants, etc.) Other If other, please describe:
Client Census (not required)
Our organization primarily serves the following populations: Asian Hispanic African-American Native American Indian Other If other, please describe:
Our organization primarily serves the following age group(s): Children Youth/Teens Elderly All ages
