Nominating Memberís Name: ________________________________________________________

100+ Women Who Care

Motown

CHARITABLE ORGANIZATION

FACT SHEET

 

1. Name of Charitable Organization

 

_____________________________________________________________________________________________

 

2. Address: (Headquarters and where services are provided, if different)

_____________________________________________________________________________________________

 

3. Web address of organization:

_____________________________________________________________________________________________

 

3. When was the organization started?

_____________________________________________________________________________________________

 

4. Mission Statement of the Organization:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

5. How would the donated funds be used?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

6. What are the current sources of funding for the Organization?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

7. What population does the Organization serve? (children, women, elderly, mentally ill, etc.) AND

how many people will receive services annually (Approximately if known)?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

8. Is the Organization a registered 501(c)(3) (IRS Certified Tax Free Status) charitable Organization?

Please Note: while a non 501(c)(3) organization is still eligible for consideration, contributions will not

be tax deductible so therefore Members must be aware of this status prior to voting.

_____________________________________________________________________________________________

 

9. If selected, would someone from the Organization be available to speak at our next meeting

to describe the impact of the donated funds?

_____________________________________________________________________________________________

 

10. Does the Organization agree not to sell, give, or use the 100+ Womenís contact information for

solicitations by themselves or other organizations?

_____________________________________________________________________________________________

 

11. If this charity is selected by the group, to whom would the check be payable to?

_____________________________________________________________________________________________

 

12. Does any portion of a contribution go toward administrative fees?

_____________________________________________________________________________________________

 

 

To be completed by Member leadership post donation:

 

Meeting Date: _____________________________________________________________________

 

Chosen Charity: ___________________________________________________________________

 

Did a representative from the chosen charity present at the following meeting to describe the

impact of the donated funds? Please describe:

_____________________________________________________

_________________________________________________________________________________

 

How much money was actually collected and donated to the charity? __________________________

I, _______________________________________ representative of _______________________________

 

(Name of representative) (Name of charity)

acknowledge our understanding that the we are prohibited from using membership information for

future solicitations or any other public use or purpose:

 

Signature: __________________________________________________________________________________

Date: ______________________________________________________________________________________