Request for Legal Assistance

Name *

Business Address

Street 1 *

Street 2 (if necessary)

Street 3 (if necessary)

City *

State *

Zip *

Email *

Phone

Fax

Date of application

Official name of organization *

Name of preferred contact at organization *

Street 1 *

Street 2 (if necessary)

Street 3 (if necessary)

City *

State *

Zip *

E-mail

Phone

Fax

Website

Preferred contact for correspondence from the NPLC?

• individual listed above or
• organization listed above

Check the box that best describes the status of the organization

• Existing Organization

  (i.e., organization does not seek incorporation or has completed all of the formation paperwork detailed above and seeks assistance with some other matter)

• Start-up Organization

  (i.e., organization needs to complete any or all of the following: Articles of incorporation, Bylaws, Board formation, 1023 application for 501(c)(3) status)

If an existing organization, how long has your organization been functioning?

• Less than one year
• One to five years
• More than five years

Check the box that best describes the services the organization provides to its target population.

• Educational
  
• Religious
  
• Arts
  
• Health
  
• Social
  
• Economic
  
• Community
  
• Other

In which state does your organization function?

If applicable, in which state is your organization incorporated ("not applicable" if not incorporated)?

If your organization is tax exempt by the IRS, under what section of the Internal Revenue Code (e.g., 501(c)(3), 501(c)(4)) ("not applicable" if not tax exempt)?

Please describe the mission or purpose of your organization or proposed organization. Please feel free to mail any additional materials, including brochures, mission statement, or business plan.

Has a lawyer or other clinic worked on this legal issue for you or the organization previously?

• No
• Yes

If so, please tell us:

• What organization, firm or office? Please include city/state of attorney
• What was the extent of previous legal work on this specific legal matter?
• Why is the previous attorney no longer handling this matter?

In the last two fiscal years, has the entity’s funding been:

• Less than $5000 total
• $5000-$100,000 total
• $100,000 or more

What are the funding commitments to the entity for the next fiscal year?

• None
• Less than $5000 total
• $5000-$100,000 total
• $100,000 or more

How often does the board meet?

If your organization has employees, either full-time or part-time, please list the approximte number of total employee hours:

If your organization utilizes volunteers please list the approximate number of total volunteer hours per month:

Please mail, using the NPLC mailing address, any of the following documents, if available:

1. certificate of incorporation or articles of association
2. by-laws
3. IRS determination letter
4. brochures or other materials describing the organization
5. grant proposals or solicitations for funds
6. most recent financial statement or, for new organizations, income and expense budget for coming year