December 21, 2017 steve Apply for Fiscal Sponsorship (Pre-Approved Project) General Information: This form is for you to confirm your desire to contract with Mission.Earth for fiscal sponsorship services and to confirm your contact and project information. This application form is for pre-approved projects only.Do you want to contract with Mission.Earth for Fiscal Sponsorship Services? YesNo Basic Information:Today's Date: *Organization Name: *If you do not have an "organization" please fill in a project name or title for mutual reference.Contact Name: *Phone: Email: *Website: If you have a website, please provide the url.Mailing Address: *We will need a physical address for verification purposes.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryType of Organization: *CorporationLimited Liability CompanyUnincorporated AssociationTrustPartnershipNeighborhood GroupIndividualOtherOther: If you chose "Other," please specify: Mission and Plans:What is your organization's or project's mission and vision? *What categories best describe your project's work? *Addiction TreatmentArts and CultureChildren, Youth & FamiliesDisaster ReliefEconomic DevelopmentEducationEnvironmentFaith BasedFestivals & EventsHealth & NutritionHousingInternational DevelopmentMental HealthPeople or Communities of Color / MinoritiesPolitical AdvocacySocialSocial / Human ServicesSocial JusticeTransportationWomenYouth DevelopmentOther Authentication and Compliance:Compliance Statement: By clicking "Submit" below, you are representing and warranting that the information you have provided in this application is true and accurate to the best of your knowledge and belief. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
