Tallahassee NPEP Application Form

General Information:
The information below is to help determine your organization's eligibility for a customized model session.
Program *
First Name *
Middle Name
Last Name *
Title or Position *
How long have you been in this position?
# of Years: *
# of Months (0-12): *
Race/Ethnicity *
Email Address *
Phone *
Phone Type *
Phone2 *
Phone Type 2 *
Organization Information:
Organization Name *
Address 1 *
Address 2
City *
State *
Zip *
Type of Organization *
Nonprofit Legal Entity *
If "Other", please specify
Are you the Founder? *
Describe your Mission *
Is this a Home-based Organization? *
Do you have a Board of Directors? *
If "Yes", how many? *
If Selected, will session include the Board of Directors?
Staff and/or Volunteers
Nonprofit/Organization Full-time Employees (#) *
Nonprofit/Organization Part-time Employees (#) *
Nonprofit/Organization Contract Employees (#) *
Nonprofit/Organization Volunteers (#) *
Prior Year Gross Revenue *
Prior Year Expenses *
Social Media:
Website Address:
www.facebook.com/
www.instagram.com/
www.linkedin.com/in/
www.twitter.com/
Narrative:
Please describe your role and the critical decisions in which you are involved.
Role and Decisions *
What are your organization's most important goals for the next five years?
Goals *
What are the top three challenges of your organization?
Challenges *
What outcomes are you hoping to achieve through this session?
Outcomes *
Who will attend the session along with the CEO/Executive Director?
Attendees *
How did you hear about us? *
Separate from this program, the Jim Moran Institute offers exclusive programs for FSU alumni and military Veterans. For informational purposes only:
Have you attended Florida State University?
Are you a Veteran?
Are you an immediate family member of a Veteran?
By submitting this registration, I acknowledge that, if selected, attendance and participation in the session is mandatory. In addition, I consent to allow the Jim Moran Institute to use all photographs and videos taken at this event in future marketing efforts.
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General Information:

Organization Information:

Staff and/or Volunteers

Social Media:

Narrative:

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