Name
*
First Name
Last Name
First Name
*
Last Name
*
Email
*
youremail@yourdomain.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization Website
*
https://yourwebsite.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Federal Tax ID (EIN)
*
Organization Type
*
501(c)(3) charitable organization
Faith-based organization
Other
Primary Operating Location
*
Springfield, Illinois
Other Sangamon County location
Outside Sangamon County (not eligible)
Annual Operating Budget
*
Under $50,000
$50,000 - $150,000
$150,000 - $300,000
> $300,000
Primary Funding Sources
*
Individual private donations
Corporate donations/sponsorships
Federal grants
State grants
Local government funding
Foundation grants
Other
Are you willing to provide your current fiscal year operating budget if requested?
*
Yes
No
Approximately what percentage of your total funding comes from federal or state grants?
*
Has your organization received a Stories Untold project in the last two years?
*
Yes (not eligible)
No
Unsure
What is your organization's mission?
*
0/500
What other organizations in Sangamon County provide similar services?
*
0/300
What is your vision for this video project?
*
0/750
What is your ideal delivery date?
*
/
Month
/
Day
Year
Date
Please verify that you are human
*
Submit
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