Academy Member Profile

We'd like to learn a little more about you and your organization. Please take a few minutes to complete the following information request. Thank you!

1. Your Name *

First

Last

2. Your Title *

3. Organization Name *

4. Business Address *

City *

State *

Zip Code *

5. Phone *

6. Email *

7. Website / URL

8. Number of Board Members:

9. Number of Paid Staff:

10. Number of Volunteers:

11. What is your organization's mission statement?

12. Which charitable category best describes your organization?

13. What services are offered by your program?

14. What is your nonprofit's annual gross revenue?

15. Please share your expectations for the Academy Membership:

16. Additional Comments:

17. We are developing a member contact list. What information can we share with other Academy members regarding your organization? *

Phone