Application for Volunteer Business and Legal Services (Combined)

Application for Volunteer Business and Legal Services
Are you applying as an individual or an organization?*
Organization Name*
Primary Contact*

First NameLast Name
Email*
example@example.com
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name*

First NameLast Name
Professional Name
Website
Preferred Language
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Confidentiality Notice: To protect your confidential information, please do not include any confidential information in this application or during any initial discussions with Arts Council staff or your volunteer. Confidential information should only be shared under the terms of an agreement between you and your volunteer.
Please check the box(es) below that relates to the CURRENT state of your organization:

Nonprofit/501(c)3New organization that has not formed a legal entityOrganization operating under a fiscal sponsor and/or other nonprofitFor profit organizationOther
Financial Information Required for Eligibility:

Your organization's application for assistance will not be processed without confirmation of your current operating revenue. Assistance for certain matters is limited to organizations whose gross revenues are $1 million or less.
Organizational Operating Budget Size*
Please briefly describe the nature of your organization's artistic activities and/or purpose*
Briefly describe the nature of the problem or need for which you are requesting assistance.*
Eligibility Requirements:

There are three criteria that we review to determine your eligibility to utilize this program.

Eligibility includes:

● Being a resident of Allegheny County, Pennsylvania

● Having an income level below 250% of the federal poverty level, as defined every January by the US Department of Health & Human Services

● Having a request that is related to your personal arts practice
Please provide material relevant to your request for assistance including your most recently completed federal tax return or other acceptable confirmation of income.*

Cancelof
Please list ALL names and addresses of additional parties involved with your legal request. For example, list other individuals, board members, corporations, attorneys, etc. involved with or against you. Attach additional pages if necessary. Enter N/A if not applicable*
Why do we ask for this? The volunteer involved in your request will need to make sure that there is no conflict of interest between anyone involved in this matter and the other clients they already represent.
By checking the box below, I hereby affirm that the information contained in this application is correct and, to the best of my knowledge, complete. This questionnaire fully and accurately describes the problem(s) for which the within named individual requests assistance. I understand that: (1) Greater Pittsburgh Arts Council (GPAC) cannot guarantee that a volunteer will agree to take on your request; (2) GPAC will not be responsible for the outcome of any request handled by a volunteer; (3) I am free to engage or decline any volunteer who may offer to assist; (4) the scope of any assistance by a volunteer is limited to the above described problem as may be further defined in any subsequent engagement letter or project summary between the volunteer and me; (5) The volunteer may withdraw from the engagement if I insist on taking action with which the volunteer has a fundamental disagreement or is beyond the objectives of the assistance; (6) GPAC does not make any representations or guarantees about the quality of services I will receive; (7) I will be advised by the volunteer, and not GPAC; and (8) I agree to promptly notify GPAC if I no longer require the services of a volunteer.
I hereby affirm that the information contained in this application is correct and, to the best of my knowledge, complete.*

Affirm
Greater Pittsburgh Arts Council funding sources frequently ask for documentation regarding who we have served. If it is determined that you are eligible for assistance, may we list your name? (Your answer does not affect your eligibility in any way.)

YesNo
I would like someone to contact us about membership in the Arts Council.

YesNo
The Arts Council has made a commitment to our funders and community to prioritize advancing diversity, equity, inclusion, and accessibility in all facets of our work. We collect demographic data to hold ourselves accountable to this commitment. The information you provide remains confidential and individual information will never be shared with anyone outside of our organization. If we do publish data on demographics, only statistical information — and no identifying information on individuals — will be shared. Submitting this information is completely voluntary, but we hope you’ll opt into participating.
Race
Does 51% or more of your board/leadership identify as BIPOC? BIPOC refers to Black, Indigenous, People of Color.

YesNo
Does 51% or more of your staff identify as BIPOC? BIPOC refers to Black, Indigenous, People of Color.

YesNo
Does your organization primarily serve any of the following populations? (select all that apply)

BIPOC (Black, Indigenous, People of Color)Individuals below the poverty lineIndividuals in institutions (ex: hospitals, nursing homes, correctional facilities, shelters, etc.)Individuals with limited English proficiencyLGBTQ+People with disabilitiesSeniorsVeteransYouthOther
Should be Empty: