Chrysalis Foundation Community Grants Program Organization Profile
Please submit or update this profile annually if your organization intends to apply for Chrysalis funding. This profile helps Chrysalis confirm eligibility, maintain compliance records, and understand where community grant funding is invested.
Organization Information
Name of Organization
*
Legal Name (If Different)
Acronym (if applicable)
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
*
Format: (000) 000-0000.
Website
*
Year Founded
*
Fiscal Year Start / End
*
Contacts
Top Executive Name
*
First Name
Last Name
Top Paid Staff Person Name
*
Top Executive Title
*
Top Paid Staff Person Phone Number
Format: (000) 000-0000.
Top Executive Email
*
example@example.com
Grant Contact Name
*
First Name
Last Name
Grant Contact Person Name
*
Grant Contact Title
*
Grant Contact Phone
*
Format: (000) 000-0000.
Grant Contact Email
*
example@example.com
Legal and Tax Status
EIN
*
Legal / Tax Status
*
501(c)(3)
Public school or school district
Government entity
Applying with a fiscal sponsor
Other
Fiscal sponsor information, if applicable (see section below)
If applying with a fiscal sponsor:
Fiscal Sponsor Legal Name
Fiscal Sponsor EIN
Fiscal Sponsor Contact Name
First Name
Last Name
Fiscal Sponsor Contact Title
Fiscal Sponsor Contact Email
example@example.com
Fiscal Sponsor Contact Phone
-
Area Code
Phone Number
Upload fiscal sponsor agreement or letter confirming sponsorship
Browse Files
Cancel
of
Who should receive payment if funded?
Applicant
Fiscal Sponsor
Who is responsible for grant reporting?
Applicant
Fiscal Sponsor
Both
Mission and Activities
Mission Statement
*
Brief Description of Core Activities
*
Primary Community Served
*
Age, Socio/Economic Status, Race/Ethnicity
Geographic Area Served
*
Annual Service Information
For most recently completed calendar year, please provide unduplicated numbers to the best of your ability.
Total Individuals Served
*
Total Girls/Women Served *Chrysalis defines women and girls as anyone who identifies or has been socialized as female
*
Total Girls/Women Served in Polk, Dallas, and Warren Counties
*
Demographic information, if tracked: Please describe the people your organization serves, including meaningful demographic information that helps Chrysalis understand where funding is invested. This may include age, gender, race/ethnicity, income level, geography, lived experience, or other relevant characteristics. Estimated or narrative context are acceptable.
Organizational Capacity
Spaces for number entry.
Full-Time Staff
*
Part-Time Staff
*
Board Members
*
Volunteers, optional
*
Annual Operating Budget
*
Required Documents
Date of IRS Determination Letter
/
Month
/
Day
Year
Date
Programming Site(s) (If Different from Above)
Organization PRIMARY Area of Focus
Safety
Security
Education
Economic Empowerment
Does the organization have a current strategic plan?
*
Yes
No
Does the organization conduct an annual audit?
*
Yes
No
IRS Determination Letter
*
Browse Files
Cancel
of
Board of Directors Contact List
*
Browse Files
Cancel
of
Certificate of Insurance
*
Browse Files
Cancel
of
Annual Budget
*
Browse Files
Cancel
of
Copy of Organization Strategic Plan (If Applicable)
Browse Files
Cancel
of
*
I certify that the information provided is true and correct to the best of my knowledge and has been reviewed and approved by the organization's chief executive, board president, or authorized representative. I understand that false or misleading information may disqualify the organization from consideration for Chrysalis funding.
*
I understand that submitting this profile does not guarantee funding from Chrysalis.
Save
Submit
Should be Empty: