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Client Intake Form

Future Leaders Empowered Inc. Nonprofit Intake Form

Future Leaders Empowered Inc.

Nonprofit Formation & Program Readiness Intake Form

Client Information

Full Name *

Phone Number *

Email Address *

EIN, if already issued

Mailing Address *

Proposed Nonprofit Organization

Proposed Organization Name *

State of Formation *

Mission or Purpose of the Organization * Who will the organization serve? * Programs or services the nonprofit will offer *

Board of Directors

Please provide at least three proposed board members, if available.

Board Member 1

Board Member 2

Board Member 3

Funding & Financial Expectations Expected First-Year Revenue Anticipated Funding Sources

Donations Grants Sponsorships Program Fees Fundraisers Other

Will the nonprofit apply for grants?

Yes No Unsure

Will the organization accept donations?

Yes No Unsure

Additional Notes Is there anything else we should know about your nonprofit vision, timeline, or support needs?

Note: This form template must be connected to your website form handler, CRM, Google Forms, Jotform, Tally, or email automation before submissions can be received.

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