LOB NonProfit Application

Organization Name *

Incorporation Year *

Organization's website *

Organization’s mission *

Primary group served *

Organization Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Annual Budget *

# of Paid Staff *

Current Board size *

# of Volunteer Staff *

Maximum board size according to bylaws *

Directors & Officers Liability Insurance provider *

Point of Contact (POC) First Name *

Point of Contact (POC) Last Name *

Submit as a company

POC Title *

POC Email *

POC preferred phone # *

Organization forms submission

Please complete this form ( https://forms.gle/SW1haCnZvFs7wUdFA ) to submit your organization's forms that we need to have on file. We will email you to confirm that we have everything & include next steps.