Request for Fiscal Sponsorship
Application Questionnaire
* To move to the next available field use the TAB key
Date of request:
Name of Project:
Name of Principal Contact:
Telephone:
Email (required):
Address:
Website:
Applying for:
Model A
Model C (Check one)
1. What is the legal status of this project? (Check one)
Sole proprietorship
Unincorporated association
California nonprofit corporation
501(c)(3) Corporation
Governmental Agency
A fiscally sponsored project of another 501(c)(3) organization
Other:
2. Nonprofit purpose of the project (one sentence):
3. Current Project Assets—how much do you have now? $
4. Anticipated Annual Budget: $
5. Anticipated Source(s) of Revenue; please indicate status of funding (received,
committed, applying, etc.):
Foundation Grants: $
Events: $
Government Grants: $
Fee for Service: $
Donations: $
Other: $
6. Number on Advisory Committee (minimum of three):
Page 1 of 4
REV. 5/24/10
Community Initiatives Application Questionnaire (continued)
* To move to the next available field use the TAB key
7. Number of each of the following:
Employees
Volunteers
Independent Contractors
FYI, for budgeting purposes, Community Initiatives’ adjusted labor burden (cost of benefits and employee-paid taxes) is 28% of
the base salary. In order for CI to enroll employees, the project must maintain a payroll reserve equal to three months of salary,
benefits and vacation accrual. Please be prepared to explain how your project will handle the payroll reserve requirement.
8. Do you anticipate that the project will include any of the following activities? If so,
please describe each of the anticipated activities:
Supporting or opposing any federal, state, or local legislation?
No
Yes If yes, please describe anticipated activities:
Supporting or opposing any initiative, bond, or other ballot measure to be voted on
directly by the general public?
No
Yes If yes, please describe anticipated activities:
Encouraging the public to support or oppose any such legislation?
No
Yes If yes, please describe anticipated activities:
Conducting voter registration, get-out-the-vote, or other activities related to
elections?
No
Yes If yes, please describe anticipated activities:
Supporting or opposing, or favoring or disfavoring, any candidate for election to
public office? (Note: Federal tax law prohibits Community Initiatives and its sponsored
projects from supporting or opposing any candidate for election to public office. Any
project that anticipates conducting such activities is not eligible for fiscal sponsorship by
Community Initiatives.)
No
Yes If yes, please describe anticipated activities:
9. Has the project created or acquired any significant intellectual property to date, or
do you anticipate having any (e.g., website, program materials, electronic media,
publications, graphics, photos, artwork, member or donor lists)?
No
Page 2 of 4
Yes If yes, please describe:
REV. 5/24/10
Community Initiatives Application Questionnaire (continued)
* To move to the next available field use the TAB key
10. Do/would any of your anticipated project activities involve risk or require special
insurance coverage?
No
Yes If yes, please describe:
11. Do you anticipate any administrative difficulties for Community Initiatives in
managing this project?
No
Yes If yes, please describe:
12. Are you currently using another fiscal sponsor?
Fiscal Sponsor Name:
Phone:
No
Yes
Name of contact:
Email:
Please describe their attitude toward this transfer:
13. Are you exploring other fiscal sponsors for this project?
No
Yes
Who?
14. How did you find us?
15. Project location/area of service by county (check all that apply):
Alameda
Contra Costa
Marin
Napa
San Francisco
San Mateo
Santa Clara
Solano
Other U.S. locations:
Sonoma Other California counties/regions:
16. Content Type (check all that apply):
Arts & Culture
Education
Public Affairs
Other:
Environment
Health
Human Services
17. Community Initiatives qualifier (check all that apply):
A project seeking incubation
 Have you applied for 501(c) (3) status?
No
Yes
 Do you anticipate applying within the next five years?
No
Yes
Maybe
A funder-instigated or multi-funder collaborative project
Page 3 of 4
REV. 5/24/10
Community Initiatives Application Questionnaire (continued)
* To move to the next available field use the TAB key
 Is more than one foundation involved in launching this project?
No
 Is this project the result of a single funder’s initiative?
No
Yes
Yes
A project of limited duration
 Is this project a one-time special event?
No
Yes
 Do you anticipate this project being completed within the next two years?
 Do you anticipate this project being completed within the next five years
 Do you anticipate the project lasting ten years or more?
No
Yes
No
No
Yes
Yes
APPLICATION CHECKLIST
Have you:
Filled out all items on this questionnaire?
Attached a description of your project indicating the following?

When it began

Its size, scope, and aspirations

Its nonprofit purpose

The number of participants

The target beneficiaries of your activity
Attached an income-and-expense budget for this current year and past year, if available?
Attached a list of your Advisory Committee (minimum of three) with their contact information and brief
biographies?
Attached a bio or resume for the project director?
Please submit your application to Prudy@CommunityIn.org.
Page 4 of 4
REV. 5/24/10