GearUp Grant Questionnaire

Point of Contact Information

Please provide the information for the person who we will be primarily contacting for the completion of this service.

Name*

First Last

Telephone*

Email*

Is the Point of Contact the Executive Director of the organization or not?*

Yes; the Point of Contact is the Executive Director
No; the Point of Contact is not the Executive Director

Executive Director Contact Information

Executive Director Name*

First Last

Executive Director Telephone*

Executive Director Email*

Executive Director Address*

Street Address Address Line 2 City State ZIP Code

Organization Information

Name of Organization Applying for Grant (legal name)*

Date of Organization's founding*

EIN Number*

Organization Address*

Street Address Address Line 2 City State ZIP Code

Organization Phone

Organization Website

Organization Social Media

You can submit any links you have for your organization's social media.

Social Media Platform	Social Media Link

Is the Organization a 501(c)(3)?*

Yes
No
Pending

Mission Statement of the Organization*

What are your funding goals?*

Grant Funding Information

Brief Summary of program or organization's activities which requires funding*

What community need or problem is the organization planning to address?*

Please state the specific community in which you will be addressing the need*

Will your focus by city-wide, county-wide, state-wide, or national?*

What are the goals of your organization or program?*

Do you have a budget? If so, please upload.

Corporate Sponsorship Information

For the 100 Business List that you will receive, we will utilize a database and certain parameters to find the best businesses for you to reach out. When asking for donations, local businesses will have the highest return of motivation and access to give your program or event. Please select some of the following if you have a specific search you’d like for us to return. If you do not choose any, we will do our best to find something that best suits your organization.

Keywords for Industry Type (Examples, Technology, Universities, Medical Offices, Restaurants)

Free text, please separate by comma

Will you be supplying a logo for the sponsorship proposal?*

Yes
No

Upload your logo*

What is the ZipCode for the list of businesses you’d like us to research?*

ZIP Code

What should be the mile radius around the zip code that we use to search?*

Which colors would you prefer on the sponsorship proposal?*

Please select the sample for your sponsorship proposal.*

Terms and Conditions

By checking the box below you agree to all of the following:*

You can read our terms and conditions here.
I agree to the following:
- I agree to Product Terms
- I agree to General/Payment & Email Terms
- I agree to Revision & Cancellation Policy
- I understand that filing fees (if applicable) ARE NOT included in any order.
- I certify that I am the cardholder and authorized to make this decision on behalf of the stated company. I will assume financial responsibility for the payment of services ordered.
- I hereby confirm my order and have read and agreed to the stated service terms and conditions, I also understand that this electronic signature will be given the same legal effect as written and signed paper communications, in compliance with the: Electronic Signatures in Global and National Commerce Act.
- I also agree to receive a weekly Marketing Email.

I agree

Once the questionnaire is completed we may need to schedule a brief telephone call to get additional information. Please let us know what date and time you would prefer for your appointment. Keep in mind unless this is an expedited order we may need at least 48 hours to confirm an appointment. Also our normal appointment times are Mon-Fri 10 am 2pm or 4 PM Eastern time. Please select the preferred day and time options on the next page and we will contact you back to confirm the appointment:

Comments

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