Starting a Nonprofit – Premium Please enable JavaScript in your browser to complete this form.Dewlyn Nonprofit Services uses this questionnaire to gather a large amount of information in a concise and efficient way. We have added both open and closed questions to collect data that will help us determine which IRS 1023 form will be needed, and to determine your nonprofit charitable purpose. Note: This form does not represent a business relationship or an agreement to engage in formal services. Once this form has been completed and submitted, we will contact you to discuss our next steps if it is determined that we are able to assist you.About Your OrganizationPrimary Contact Name *FirstLastContact Title *Organization Name *Organization AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCounty *Email *Website / URLPhone *Date Organization Originally FoundedEmployee Identification Number (EIN) – Only if Applicable.Do you anticipate gross receipts that exceed $50,000 in any of the next 3 years? * YesNoI am not sureDo you have assets that exceed $250,000 in fair market value? * YesNoAre you applying for reinstatement of a previously revoked 501(c)(3) organization? * YesNoHow is organization structured? * For-ProfitNon-Profit CorporationNon-Profit (Other)We do not have a legal structure yetAbout Your Registered AgentIn United States, a registered agent is a business or individual designated to receive service of process when a business entity is a party in a legal action such as a lawsuit or summons. A registered agent can serve more than one role in the organization.Registered Agent Name *FirstLastRegistered Agent Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeRegistered Agent Email: *Registered Agent Phone: *About Your Board of Directors and OfficersThe number of Directors and Officers required vary from state to state. A best practice is to have at least 3 (unrelated) individuals to serve your organization. Typical Board positions are: Board Chair, Board Treasurer, Board Secretary, and Board Member. Typical Officer positions are: CEO, CFO, and Secretary.Number of Directors: *THE BOARD CHAIR *FirstLastChair's Email *Chair's Phone Number:The Board Chair serves as: * Only the Board ChairThe Board Chair and the CEOI would like to discuss thisTHE BOARD TREASURER *FirstLastTreasurer Email" *Treasurer Phone Number: *The Board Treasurer serves as: * Only the Board TreasurerThe Board Treasurer and the CFOI would like to discuss thisBOARD SECRETARY *FirstLastSecretary Email *Secretary Phone Number:The Board Secretary serves as: * Only the Board SecretaryA board member and officerI would like to discuss thisPlease use the space provided to list all other board members. List their name and email.Do you plan to compensate your board? * YesNoI am not sureAbout Your Organization's ActivitiesWill this organization be established as a Public Charity or Private Foundation? Public Charities generate a substantial amount of their income to further its mission from public sources (i.e. grants, donations, contributions from the public or government). Where as, Private Foundations substantially obtain their income from private sources (i.e. their private funds, their family, friends, or company), and these organizations support the work of the Public Charity. * I am forming a Public CharityI am forming a Private FoundationI would like to discuss thisTo qualify for exemption as a section 501(c)(3) organization, you must be organized and operated exclusively to further one or more of the following purposes. Which of the following purposes apply to your organization? * CharitableReligiousEducationalScientificLiteraryTesting for Public SafetyFostering national or international amateur sports competitionPreventing cruelty to children or animals.Will your organization conduct activities outside of the United States? * YesNoI am not sureWill your organization provide disaster relief? * YesNoI am not sureWill your organization provide grants or assistance to individuals or other organizations? * YesNoI am not sureIn under 20 words, please state your organization's mission: *In under 20 words, please describe what the organization will do? (i.e. services) *How did you hear about our services? * Our Website/Team MemberPostcardOnline SearchI was referredOtherWho were you referred by?If you selected "Other," please explain (thank you)!I have reviewed this information and I attest that it is true to the best of my knowledge. * Yes, this information is correct.Submit