Online Application Strengthening the CircleA Native Nonprofit Leadership Program Which gathering are you applying for? Virtual Gathering Bozeman Gathering Keystone Gathering Executive Director/Board Member Name * First Name Last Name Title Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number * (###) ### #### Email Address * How long have you been the Executive Director? * FINANCE MANAGER -OR- BOARD MEMBER Name First Name Last Name Title Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number (###) ### #### Email Address Are you able to join for the full gathering? Select one Yes No ABOUT YOUR ORGANIZATION Organization Name * Mailing Address (Organization) * Address 1 Address 2 City State/Province Zip/Postal Code Country Does your organization have 501(c)3 (tax exempt) status? * Select one Yes No If not, is your organization: Incorporated by a state Incorporated by a Tribe Fiscally sponsored by another organization under a formal agreement Other Other: How long has your organization been in existence? * What is your organization's mission? * What is your organization's purpose? * Do you have goals for this year? If so, what are they? * Is there anything you would like to teach or share at STC? * What is the approximate annual budget for your organization? * under $10,000 $10,000 – $25,000 $25,000 – $50,000 $75,000 – $150,000 $150,000+ Number of Full-time Paid Staff: * Total staff / # of Native staff / # of Non-Native staff Number of Part-time Paid Staff: * Total staff / # of Native staff / # of Non-Native staff Number of Volunteers: * Total volunteers / # of Native volunteers/ # of Non-Native volunteers Number of Board Members: * Total members / # of Native members / # of Non-Native members Is your organization part of a coalition or member organization? * Select Yes No If yes, who are you affiliated with? Please describe your organization's experience in applying for, receiving, and managing grants: * We have no experience in this area We have tried and failed We have tried with mixed success We have had some success We have been very successful raising money through grants Who has been doing the grant writing? * Has your organization ever received a grant from a state or federal agency or private foundation to provide services? * Select one Yes No If yes, what services? Is there any other information you would like to share? STC consists of a four-day session with continued follow-up support year round. The cost of travel, lodging, food, and all instruction is included. Please add any suggestions for this training or additional information about your organization that you would like us to know. Thank you for completing this application! Thank you!You should hear from us in a few weeks.
