Carbon County Community Foundation

Carbon County Community Foundation

Nonprofit & Community Organization Needs Assessment
The Carbon County Community Foundation is asking representatives from area nonprofits to complete the following short online survey to share information about your organization, any ongoing needs, and upcoming challenges or opportunities you are facing.

The Foundation will be using the information gathered to create a knowledge database about the nonprofit sector in Carbon County. The information will help us secure and allocate future funding and other resources to support the region.

Qualified organizations who complete the survey by August 11th will be entered into a random drawing to receive a $500 donation.
Organization Name*
Organization Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Phone Number
Please enter a valid phone number.
Organization Email
example@example.com
Organization Website
Are you a 501c3 organization?

YesNoOther
If you are NOT a 501c3, what type of organization are you? Or are you in the process of getting approval as a 501c3?
Primary Contact Name*

First NameLast Name
Primary Contact Position*
Primary Contact Email
example@example.com
Primary Contact Phone Number
Please enter a valid phone number.
Number of Full Time Employees
Number of Part Time Employees
Number of Volunteers
Organization Mission Statement*
General Description of Services Provided to the Community*
Year Founded*
Annual Operating Budget (Expenses)*
Total Assets/Savings (if any)
Does your organization make use of any investment vehicles (stocks/bonds/money market funds/CDs/etc)? Are you interested in starting an endowment and taking advantage of some of these vehicles?
Services Provided to Carbon County by Your Organization

For each general area, please select the services you provide and the areas of the county in which you offer those services. If none, select "None" at the bottom of each column.

Health and Human Services*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
Food Assistance
Clothing Assistance
Men's Shelter
Women's Shelter
Family Shelter
Rent Assistance
Utility Assistance
Healthcare Access
None

Education and Scholarships*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
Early Childhood Development Programs
Primary Education Programs
Secondary Education Programs
Primary Education Scholarships
Secondary Education Scholarships
Higher Education Scholarships
None

Community and Economic Development*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
Fire
Police
Emergency Medical Services
Emergency Management
Community Center
Parks/Recreation
Civic Organizations
Workforce Development
Career Development
Public Transportation
Childcare
Library
None

Senior Programs*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
Food Delivery
Social Activities
Senior Housing
None

Youth Programs*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
School Supplies
Scouting
Summer Camps
After School Programs
Summer Food Programs
Sports Programs
Extracurricular Programs
None

Veteran Programs*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
Counseling
Food Programs
Social Activites
Housing Assistance
None

Environment and Historical Preservation*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
Historical Societies
Public Access
Conservation Programs
Sustainability Programs
None

Arts and Culture*

	Jim Thorpe	Lehighton	Palmerton	Panther Valley	Weatherly
Community Music Programs
Community Theater Programs
Community Art Programs
Public Beautification
None

Client Eligibility Requirements (if any)*
What are the top three resources your organization needs at this time or in the near future?*
Funds, board members, training, staffing, volunteers, etc
Describe any upcoming opportunities for the future:*
We want to know what your 5 and 10 year goals are. Are you starting new programs? Are you expanding into new areas? Are you collaborating with other organizations? What, if anything, is standing in your way?
Other Comments:
Anything else you'd like us to know and include in our database about your organization.
Should be Empty:

Services Provided to Carbon County by Your Organization