NON-PROFIT FORMATION & DEVELOPMENT INTAKE FORM

CLIENT INFORMATION

Client/Organization Name:

Primary Contact Name:

Phone Number:

Email Address:

Business Address:

City, State, Zip:

Proposed Nonprofit Name:

Proposed Service Area (City/County/State):

Target Population Served:

REQUESTED SERVICES, FEES & TURNAROUND TIME

Service	Fee	Estimated Turnaround Time
Advisory Board Registrant Documentation	$100.00	1 business day
Bylaws Development	$ 90.00	1 business day
Mission & Vision Statement Development	$ 25.00	1 business day
Program Development	$TBD	1 week(s)
Organizational Budget Development	$150.00	1 week(s)
Program Budget Development	$TBD	1 week(s)
Ohio Secretary of State Registration for Nonprofit Domestic Corporation (State Fee $99)	$25.00	1 day
Employer Identification Number (EIN) Filing	$25.00	1 day
Ohio Attorney General Registration	$40.00	1 day
IRS Form 1023 Completion (501(c)3 Application Fee $275)	$50.00	1 day
Board of Directors Orientation ($100)	$TBD	________ weeks
Grant Readiness Package ($150)	$TBD	________ weeks
NON-REFUNDABLE DEPOSIT:	$505.00

ORGANIZATION OVERVIEW

Mission Statement:

Vision Statement:

Core Programs/Services:

Projected Annual Budget:

Funding Sources:

Number of Board Members:

Key Community Partners:

LEGAL DISCLAIMER / HOLD HARMLESS

J&S Marketing Resources, Inc. provides business consulting and administrative support services only and does not provide legal advice. Client agrees to hold harmless and indemnify J&S Marketing Resources, Inc. from claims arising from the nonprofit’s filings, operations, compliance, or governance decisions.

I agree to the terms above.

CLIENT SIGNATURE

Client Name (Printed):

Client Signature (Type Full Name):

Date:

Beyond the ordinary

This is where your journey begins. Get to know your business and what you plan to do, and how you're committed to quality of service and improving the quality of people's lives. Join us as we grow and succeed together. We're glad we're here to be a part of your story.