Date:
Name of Organization:
Street Address:
City:
State:
Zip:
County:
Email: *Required	(Ex: email@yoursite.com)
Executive Director:
Chair or President of Board:
Contact Person:
Daytime Phone:
Does your organization carry Association Liability Insurance :	Yes No
Date of IRS letter granting 501(c)3 status and/or incorporation date:
Organization Mission:
Summary of Current Programs/Services:
Financial Management
Does your organization have a paid bookkeeper or accountant?	Yes No
If no, is there a volunteer who provides the bookkeeping services?	Yes No
Are the accounting records computerized?	Yes No
If yes, what software is currently used?
Finances
Fiscal year: Check one:	Dec 31 May 31 June 30 Sept 31 Other:
What was your organization's income and expense for the most recently completed year?
Income:
Expense:
Current Year Budget:
Community Development Cultural Education Health Human Services Environmental Housing Religious Youth Other:
What are your requirements for a Community Accountant's referral?
Are you applying for one person who will be Board of Directors member,	Yes No
and/or A member of one of your committees	Yes No
Name of Committee
Name of Committee Chair
Day Time Telephone Number
Time, day and location of Board or Committee meetings:
Do your by-laws or policy statement stipulate requirements regarding board member attendance at meetings?	Yes No
If yes, please state what they are:
Are there specific requirements for the board membership such as place of residence, membership in organization?	Yes No
If yes, please state what they are:
Do you require a CPA?
Do you want an accountant who will actually keep the books, sign checks, etc?	Yes No
Are you looking for someone to provide oversight to the person who keeps the books?	Yes No
Do you have additional needs of your volunteer? (check all that apply)	Liaison with auditor Investment advice Budgeting skills Other:
Do you require that your volunteer be in a senior position?	Yes No
Accounting firms and Corporations/Nonprofit/Government
Partner Senior Executive Manager Middle Management 5 year + Supervisory
Are you willing to accept a referral of an accountant with fewer than:
Five years experience?	Yes No
Two years experience?	Yes No