Fiscal Sponsorship Application

Fiscal Sponsorship Application
Name of organization:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
State where organization is or will be incorporated:
Date of incorporation:

MonthDayYear
Date organization applied for its own 501(c)(3) if it already has:

MonthDayYear
Tell us where you are in establishing your nonprofit status:

Other
If you are spinning off from another nonprofit, please name that organization:
If are seeking a new fiscal sponsor, please state your current sponsor and reason for changing:
Target date to be operating independently, if you have one:

MonthDayYear
CEO or employee who is responsible for organization finances and development:
Name

First NameLast Name
Title
E-mail
Phone Number

Area CodePhone Number
Bookkeeping contact - person who will handle sponsorship and donation matters and be primary operational contact on a day to day basis:
Name

First NameLast Name
Title
E-mail
Phone Number

Area CodePhone Number
What is the mission of the project or program for which you are seeking sponsorship?
What funding do you have at least verbally committed to your nonprofit for the current year?

Please attach:
Your current or first-year budget with anticipated revenue, listing all sources over $25,000

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Your business plan for the current or coming year

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If not covered in the business plan, your project plan and goals for the current or coming year

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Revenue/operational and editorial/news goals

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Short bios of the top officer of your nonprofit and your board chair

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A list of all board members

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Does your organization have any debts or legal action pending against it?
If yes, please tell us about it:
Are you currently an INN member?
If no, have you submitted an INN membership application and attest your organization will operate within the transparency, editorial independence and other guidelines of INN membership?
Here's how to apply for membership.
Are you producing and publishing news at the current time?
If yes, please provide the URL where we can see your publication or if you publish through third parties, see your editorial independence and other policies:
If not, when is your target date to begin producing and publishing?
Signature
Title
Date

MonthDayYear
Should be Empty:

Fiscal Sponsorship Application

CEO or employee who is responsible for organization finances and development:

Bookkeeping contact - person who will handle sponsorship and donation matters and be primary operational contact on a day to day basis:

What funding do you have at least verbally committed to your nonprofit for the current year?

Please attach: