IntakeForm | Los Angeles Trial Lawyers' Charities |

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Organization Contact Information Name of Organization

Address

City

State ZIP

Website for Organization

Contact Person Information Name

Phone

Email Address

Please enter a valid email address.

Organization Information Date Organization was established

501 (c)(3) Federal TAX ID number

Names of all current Board Members
(enter all names and officer titles,
separate each by a comma)

Names of Executive Director

Name of Director of Development

Annual Budget

Program Expenditures (amount spent on programs and services you deliver)

Administrative Expenditures (amount spent on overhead, staff, costs, meetings, etc.)

Fundraising Expenditures (amount spent on fundraising, publicity, mailing, soliciting donations, events)

Fundraising Efficiency (amount spent to raise $1 in charitable contributions)

Amount of Grant Requested

Mission Statement

Does your organization support education, children, survivors of abuse,
persons with disabilities and/or people who are homeless? Describe how you support these groups?

Is your request tied to an event? If so, describe event and provide date, time, and location.

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Apply For An LATLC Grant