Sierra NonProfit Services 2009 Asset Mapping Survey
Information Update
1.
Contact Information
Organization's Name
Street Address
City
State
Postal Code
Email Address
Phone Number
URL
2.
Nonprofit Status:
501(c)3
501(c)6
other
3.
How long has your nonprofit organization been in existence?
One year or less
2 - 3 years
4 - 5 years
6 - 10 years
11 - 19 years
20 years or more
Unknown (esplain)
4.
Which Counties does your agency serve ?
Amador
Calaveras
Tuolumne
Mariposa
Other
5.
Does your agency provide service(s) to individuals/families living in poverty, e.g., a 3-person household income of $17,600 or less, a 2-person household of $14,000 or less, etc?
If yes, what services do you provide, or help to provide?
Yes
No
Food
Housing
Childcare
Transportation
Legal Services
Health Care
Other
6.
Is your agency an affiliate, unit, branch or franshise of a regional or national organization?
Yes
No
7.
Is your agency fiscally sponsored by another 501c3
Yes
No
8.
If yes on 8, name of Fiscal Agent:
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