501(c)(3) Nonprofit Questionnaire501(c)(3) Nonprofit Vetting Questionnaire & Due Diligence Checklist Purpose: This questionnaire is used to evaluate eligibility, transparency, fiscal responsibility, and mission alignment. Submissions may be reviewed by the Board of Directors or designated review committee.Section 1: Organization IdentificationLegal Name of OrganizationDoing Business As (DBA) (if applicable)Date of EstablishmentState of Incorporation- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificFederal EINIs your 501(c)(3) status in good standing with the IRS and your state regulators? Yes NoOrganization Website (if applicable)Primary Mission StatementSection 2: Primary Contact InformationPrimary Contact First NamePrimary Contact Last NamePrimary Contact TitlePrimary Contact Email AddressPrimary Contact Phone NumberPrimary Contact Mailing AddressAddress Line 1Address Line 2CityState Abbr.Zip CodeSection 3: Financial Transparency & Compliance (Please upload PDFs for all documentation)Required - IRS Determination LetterUpload IRS Determination Letter Required - Most recently filed IRS Form 990Upload IRS Form 990 Required - Completed & Signed IRS Form W-9Upload IRS Form W-9 Optional - Current operating budgetUpload Budget Optional - Most recently audited financial statementUpload Audited financial statement Has the organization ever had its tax-exempt status revoked or suspended? Yes NoIf yes, please explain belowSection 4: Program Efficiency Ratio (PER) & Compliance Program Efficiency Ratio (PER) is a key financial metric for nonprofits. It shows the percentage of total spending directed to core mission activities versus administrative/fundraising costs. Calculated as (Program Expenses / Total Expenses)Fiscal YearProgram Expenses ($)Total Expenses ($)PER Ratio%We certify that the Program Efficiency Ratio (PER) provided above is accurate and derived from our most recent Form 990 or audited financial statements. We understand that this information is used to evaluate fiscal responsibility and donor impact.Authorized Signatory NameAuthorized Signatory TitleSection 5: Program Alignment & Use of FundsDescription of how the requested donation/grant will be usedIntended Outcomes (select all that apply) Direct program services Emergency or crisis assistance Equipment or supplies Salaries /operational support Program expansion OtherOther detailsSection 6: Impact, Reporting & AccountabilityDoes the organization accept restricted funds? Yes NoDoes the organization track program outcomes or impact metrics? Yes NoIs the organization willing to provide post-funding impact reporting? Yes NoReporting frequency One-time Quarterly AnnuallyIf Yes, briefly describe methods usedSection 7: Governance & EthicsNumber of Board MembersDoes the Board meet at least annually? Yes NoConflict of Interest Policy in place? Yes NoAuthorized Representative NameAuthorized Representative TitleSubmit for Review
