Chrysalis Foundation 2025-2026 Community Grants Program Organization Profile
Please submit annually when intending to apply for funding from Chrysalis
Organization Information
Name of Organization
*
Legal Name (If Different)
Acronym (if applicable)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Website
*
Top Paid Staff Person Name
*
First Name
Last Name
Top Paid Staff Person Name
*
Top Paid Staff Person Title
*
Top Paid Staff Person Phone Number
*
Top Paid Staff Person Email
*
example@example.com
Grant Contact Person Name
*
First Name
Last Name
Grant Contact Person Name
*
Grant Contact Person Title
*
Grant Contact Person Phone Number
*
Email
*
example@example.com
Annually
Total Number Full-Time Staff
*
Total Number Part-Time Staff
*
Total Number Board Members
*
Total Number Volunteers
*
Tax Exempt Status
Select Which Applies
*
501(c)(3)
509(a)(1)
509(a)(2)
School
Government
Not a nonprofit organization; have a fiscal sponsor
Fiscal Sponsor Name (If Applicable)
Tax ID Number
*
Date of IRS Determination Letter
*
/
Month
/
Day
Year
Date
Organization Mission and Budget
Mission Statement
*
Brief Description of Activities/Objectives
*
Programming Site(s) (If Different from Above)
Primary Population Served
*
Age, Socio/Economic Status, Race/Ethnicity
Geographic Area Served
*
Total Number of Persons Identifying as Women and Girls Served in 2024 (Chrysalis defines women and girls as anyone who identifies or has been socialized as female)
*
Total Persons Served by Organization in 2024
*
Organization PRIMARY Area of Focus
Safety
Security
Education
Economic Empowerment
Annual Operating Budget
*
Does the organization have a current strategic plan?
*
Yes
No
Does the organization conduct an annual audit?
*
Yes
No
Required Documents
Copy of IRS Determination Letter
*
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of
Copy of Current Organization Annual Budget
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of
List of Board of Directors
*
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of
Copy of Certificate of Insurance
*
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of
Copy of Organization Strategic Plan (If Applicable)
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of
*
I certify that the above statements are true and correct and this document has been reviewed and approved by the organization's Chief Executive or President of the Organization Board of Directors. I understand that a false statement may disqualify the organization from being considered for grant funds.
*
I understand that completion of this form does not guarantee funding from Chrysalis.
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