Customarily, when a business decides to begin an aggressive grant writing program, they do not realize how much information will need to be conveyed to the person charged with putting their grant requests on paper. Please provide the following information to help us get started.

1.  Name of your Business and any AKAs



2.  Complete Address of Main Office and any other locations


3.  County in which your main office is located

4.  Main Telephone Number and Best Number to Reach Contact Person

5.  Fax Number

6.  EMail Address

7.  Web Site Address

8.  Name of the Chief Executive Officer and date hired

9.  When was your business established? Date of incorporation?

10.  Type of Business (i.e., sole proprietor/individual, corporation, partnership)

11.  If Partnership, Number of Partners and Percentages

12. Is Your Business Considered Women or Minority Owned:

13.  Federal EIN:


14.  State EIN:

15. Nature of Your Business:

16.  Type of Products or Services:

17.   Fiscal year

18.   Number of full time employees (over the past year)

19.   Number of part time employees (over the past year)

20. Number of Independent Contractors and areas of expertise (over the past year)?

21. Number of volunteers and interns? Are they compensated in any way?

22.   Geographic Market areas:

23. Annual Budget for last fiscal year

24. Annual Budget for current year

25. Projected Budget for next year (if applicable)

26. Reasons for any Significant Budget deficits/changes, etc.

27.   Is your business an active member of any coalitions and/or community groups?


28.   Previous grant history



  1. DUNS Number:

30. Are you affiliated with any collaboratives, coalitions, associations, etc?

31. Anything else you'd like to add

This form was developed by Penny Goforth of Grant Writing Specialists,

for free distribution

For more information, visit our website at