Nonprofit Client Intake Form

Future Leaders Empowered Inc.

Client Information

Full Name * Phone Number * EIN Email Address * 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

Board Member 1 — Name / Title / Email Board Member 2 — Name / Title / Email Board Member 3 — Name / Title / Email

Funding & Financial Expectations

Expected first-year revenue Funding Sources

Donations
Grants
Sponsorships
Program Fees

Will the nonprofit apply for grants?

Yes No

Will the organization accept donations?

Yes No