Want to learn more about our charity spotlight? Click Here "*" indicates required fields Step 1 of 2 50% This field is hidden when viewing the formDate MM slash DD slash YYYY Name of Organization*Name of organization Applying for Charity Spotlight:Nominated ByWhich BCA Member nominated your organization for the Charity spotlight? 1 – Basic InformationAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website* YOUR CONTACT INFORMATION Contact information for the person completing this form, will serve as main point of contact Your Name* First Last Job Title*Your Email* Your Phone #* EXECUTIVE DIRECTOR CONTACT INFORMATION Contact information for the executive Director or Head of The Organization Name* First Last Title*Phone*Email* 3- DETAILS ABOUT YOUR ORGANIZATIONWHEN WAS YOUR COMPANY LEGALLY EST?How long has the Organization been in existence?State of IncorporationIs the Organization tax exempt? YES NO Tax ID#What is the age of individuals you serve?*Select all that apply Under 6 years of age 6-13 years of age 14-18 years of age 18-21 years of age Adults Senior Citizens Select Your Non-Profit Category*Select all that apply Animals Arts, Culture, Humanities Community Development Education Environment Health Human Services International Human & Civil Rights Religion Research & Public Policy OVERVIEW YOUR ORGANIZATIONPlease provide a brief description of the Organization and your mission. (You may also attach information below)SPECIFIC INFORMATION ON FUNDSPlease give a brief description of how funds are typically acquired, the projects and how funds are typically allocated Supporting DocumentsMax. file size: 50 MB.Feel free to upload any supporting documents List of Leadership*Please list all officers, directors, trustees and/or executive management of the organization. Click the plus icon on the right to add additional shareholders.First & Last NameTitleYears with Organization Add Remove4- CONSENTBy signing below, I’m indicating that if selected to be the charity spotlight for a specified month, our organization will provide a board member, trustee or other approved high level personnel to address the BCA group for 3-4 minutes at a designated Hospitality Breakfast Event.SignaturePlease Type Name of Signer
