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Preferred Greeting: Mr.
Ms.
Mrs.
Miss
Dr.
Other (please specify):
First Name:
Last Name:
Title:
Department:
Organization Name:
Street Address:
City:
State:
Zip Code:
Telephone Number:
Extension:
Fax Number:
Email Address:
Number of Years in Philanthropy:
Education:
Degree/Level Attained:
Field of Study:
Please enter the name of the GMN member at your foundation to contact for membership contribution/grant requests:
CEO:
CEO Title:
Central Telephone Number:
Central Fax Number:
Central Email Address:
URL:
Organization Type: Community Foundation
Private Family Foundation
Corporation Foundation
Private Independent Foundation
Corporate Giving Program
Public Foundation
Operating Foundation
Regional Association of Grantmakers
Other (please specify):
Date Established:
Fiscal Year (MM/DD):
Subject Focus of Grants Awarded (check all that apply): Animals
Arts
Education
Environment/Resources
Health
Human Services
International/Foreign Affairs
Public/Society Benefit
Science and Technology
Social Sciences
Religion
Miscellaneous Mutual/Membership Benefit Organizations
Other (please specify):
Type of Support (check all that apply): Endowment Support
General Support
Capital Support
Program Support
Program Related Investments
Research
Scholarships/Fellowships/Individual Awards
Other (please specify):
Population Group Funded (check all that apply): Aging/Elderly/Senior Citizens
Children & Youth
Crime or Abuse Victims
Disabled
Economically Disadvantaged
Ethnic or Racial Minorities
Gays/Lesbians/Bisexuals/Transgender
Immigrants/Migrants/Refugees
Indigenous Peoples
Men & Boys
Military & Veterans
Offenders or Ex-Offenders
People with AIDS
Single Parents
Substance Abusers
Women & Girls
Other (please specify):
Geographic Funding Area (check all that apply): Local
State
Region
United States
International
For the last complete fiscal year please provide the following data:
Assets:
As of fiscal year ended (MM/DD/YYYY):
Number of grant proposals received:
Number of grants approved:
Total dollars awarded:
Number of active grants:
List each employee in only one category below.
Number of program staff (those involved in program decisions):
Number of program support staff (those that support program staff):
Number of grants managers/grants administrators:
Number of administrative staff (other staff such as IT or human resources):
Do you use an electronic grants management system? Yes No
If yes, which of the following systems do you use: MicroEdge GIFTS
NPO Solutions FIMS
Other (please specify):
Does your organization belong to the Council on Foundations? Yes No
Does your organization belong to a Regional Association of Grantmakers? Yes No
If yes, name of Regional Association of Grantmakers:
Comments/Suggestions: