Application for Cohort Instruction

Date

APPLICANT

Please provide the following information:

Organization *

Location:

City

State (ARC Region)

(If your location state is not listed in the drop-down field above, please select “Other” from the list)

County (ARC Region)

(If your county is not listed in the drop-down field above, please select “Other” from the list)

State & County (Other):

The following State (Other) and County (Other) fields only apply if you selected “Other” in the State (ARC Region) drop-down above.

State (Other)

(Please select your state in the drop-down field above)

County (Other)

(Please type your location county)

Zip *

Telephone Number *

Email *

Website or Facebook URL *

ORGANIZATIONAL & FINANCIAL INFORMATION

Please share some information about your organization so we may better understand the current situation and the impact COVID-19 has had. This information will only be used to evaluate your participation in the Appalachia Nonprofit Resource Center technical assistance program.

Q1.: What is your current Mission Statement? *

Q2: The Appalachian Regional Commission’s strategic plan includes five goals:

Invest in entrepreneurial and business development strategies that strengthen Appalachia’s economy;
Increase the education, knowledge, skills, and health of residents to work and succeed in Appalachia;
Invest in critical infrastructure, especially broadband; transportation, including the Appalachian Development Highway System; and water/wastewater systems;
Strengthen Appalachia’s community and economic development potential by leveraging the Region’s natural and cultural heritage assets; and
Build the capacity and skills of current and next-generation leaders and organizations to innovate, collaborate, and advance community and economic development.

How does your organization align with or address one or more of these five goals? *

Q3: IRS Filing Status *

501(c)(3)

501(c)(4)

501(c)(5)

501(c)(6)

OtherOther

(Check One)

Q4: Are you a unit or chapter of a larger organization? *

Yes

If yes, what entity?

Q5: Please complete the following information (number fill).

# of Full-Time Employees as of 9/1/2020 *

(If you don’t have any Full-Time Employees, please enter “0”)

# Full-Time Employees on 12/31/2019 *

(If you didn’t have any Full-Time Employees, please enter “0”)

# Part-Time Employees as of 9/1/2020 *

(If you don’t have any Part-Time Employees, please enter “0”)

# Part-Time Employees on 12/31/2019 *

(If you didn’t’ have any Part-Time Employees, please enter “0”)

Q6: What fiscal year cycle does your organization currently operate on? *

Calendar

July-June

October-September

OtherOther

(Check One)

Q7: To better understand your financial situation, please provide your Operational Budget for the current and last year:

Income Last Fiscal Year (Actual) * $

(Example: 100,000; don’t enter $ sign)

Expenses Last Fiscal Year (Actual) * $

(Example: 90,000; don’t enter $ sign)

Income Current Year (Projected) * $

(Example 100,000; don’t enter $ sign)

Expenses Current Year (Projected) * $

(Example 90,000; don’t enter $ sign)

Submit Current Balance Sheet (if available)

Maximum upload size: 5MB

(Any type document can be uploaded up to 5mb; – If your upload is successful, you will see a blue bar)

Q8: Do you have restricted reserves? *

Yes

(e.g. Endowment, etc.)

If yes, how much funding is available as of 9/1/2020? $

(Example 50,000; don’t add $ sign)

Q9: Have you received CARES Act funding (either directly or via a third party)? *

Yes

If yes, total amount of CARES Act funding received: $

(Example 10,000; don’t add $ sign)

Date Received:

Received From:

For what purpose(s)?

Q10: Describe how COVID-19 has negatively impacted your organization. *

(300 words maximum)

Q11: What are the three most pressing concerns for your organization’s survival during this pandemic (what keeps you up at night)?

1. *

2. *

3. *

How do you see participation in the program helping you address these concerns? *

(300 words maximum)

COHORT INSTRUCTION

Instruction will be provied to cohorts (three-four organizations – aligned by geography, size and/or sector – participating in the same topic area at the same time).

Q12: Organizations have the option of submitting applications as a proposed cohort (3-4 organizations in a geographic area or similar sector).

Are you applying as a proposed cohort? (Note: Applicants will not be penalized for selecting No). *

Yes

If yes, please list the names of the other organizations in your proposed Cohort:

(Note: Each organization must submit its own application. Organizations will be evaluated individually,)

Q13. The applicant’s Executive Director or CEO is expected to be part of the nonprofit organizational team. Will your Executive Director or CEO participate in the program? *

Yes

If No, explain why.

Q14. If selected, please indicate your top two choices using the #1 Choice and #2 Choice fields below.
*** Note: A cohort or organization may participate in only one course. ***

#1 Choice *

1-Short-term Financial Management

1-Mission & Operations

1-Long-term Financial Management

1-Fundraising

#2 Choice *

2-Short-term Financial Management

2-Mission & Operations

2-Long-term Financial Management

2-Fundraising

Q15. Select your desired course schedule using the Desired Course Schedule #1 and Desired Course Schedule #2 fields below.

Select Your Desired Course Schedule #1 *

1-Fall 2020: 6-Week Course (Nov. 9, 2020 – Dec. 18, 2020)

1-Fall 2020: 11-Week Course (Nov. 9, 2020 -Jan. 24, 2021)

1-Winter 2021 A: 5-Week Course (Jan. 25, 2021 – Feb. 28, 2021)

1-Winter 2021 B: 5-Week Course (Mar. 1, 2021-April 4, 2021)

1-Winter 2021: 10-Week Course (Jan. 25. 2021 – Apr. 4, 2021)

Select Your Desired Course Schedule #2 *

2-Fall 2020: 6-Week Course (Nov. 9, 2020 – Dec. 18, 2020)

2-Fall 2020: 11-Week Course (Nov. 9, 2020 -Jan. 24, 2021)

2-Winter 2021 A: 5-Week Course (Jan. 25, 2021 – Feb. 28, 2021)

2-Winter 2021 B: 5-Week Course (Mar. 1, 2021-April 4, 2021)

2-Winter 2021: 10-Week Course (Jan. 25. 2021 – Apr. 4, 2021)

APPLICATION SUBMITTED BY:

Name *

First

Last *

Last

Title *

Check the box below to confirm the organization’s Executive Director/CEO has approved this application for submission. *

Yes, Approved by Executive Director/CEO

Thank You!

Thank you for applying to participate in the Appalachia Nonprofit Resource Center’s technical assistance program. Please inform your ARC State Program Manager when you apply for this initiative. You will be notified if there are any questions about your application or we require additional information. Successful applicants will be notified the week of October 26.

If you are human, leave this field blank.