Member Organizational Profile Form

AFRICAN WOMEN ECONOMIC CONSORTIUM
160 CLAIRMONT AVENUE
DECATUR,GEORGIA 30030
http://www.aweconline.org

Member Information

Your Name

Name of Organization

Address

Years in Business or Beginner

Type of Organization( Profit or Non-Profit).

Number of Employees

Number of Board Members

Are You a Cooperative? How Many Members?

Do You Need Funding?

Your Phone Number

Your Business Phone Number

*

Yes - I am an American Citizen

No - I am not an American Citizen

I am a citizen of___________________________

Mission of Your Organization

Mission of Your Organization *

How Does Society Benefit From Your Program? *

What Social Problems Would Your Program Solve?

How Would Your Org. Solve this Problem? *

Who Specifically Benefits From Your Program?

What Consequences if Any May Arise if the Problem is Not Solved? *

Are You Willing to Mentor Another Woman? *

Budget

How much funding would you need? Please Break down as such: Administration: Staff: Transportation: Building (if needed): Office Supplies: Other Consumables: Other: *

Sign and Date *