Alabama Tech Grant Application Alabama Technology Assessment Grant Application PART I: ELIGIBILITY INFORMATION Please check each box to certify that: Your organization is a 501(c)(3) charitable organization (as defined by the Internal Revenue Service). The following organizations are not eligible: churches, or organizations whose primary mission is to promote a religion; private schools, colleges or universities; nonprofit hospitals or cooperative hospital service organizations; governmental agencies;Your organization has an annual operating budget in the current or most recent fiscal year larger than $50,000;Your organization demonstrates fiscal responsibility, the appropriate use of funds and accounting standards; Your organization follows EEOC guidelines and provides equal employment opportunity to all persons regardless of age, color, national origin, physical or mental disability, race, religion, creed, gender, sexual orientation, marital status, status as a disabled veteran or any other characteristic protected by federal, state or local law; andThe technology assessment will be used by an Alabama-based nonprofit. PART II: CONTACT & ORGANIZATION INFORMATION Contact Information Contact’s First Name Contact’s Last Name Contact’s Phone Contact’s Email Organization Information Organization Name Street Address City State Please select…ALAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip / Postal Code Organization’s Web Address Organization’s Mission Limit 600 characters with spaces. Year Founded Number of Current Full-time Paid Employees: Current Fiscal Year Organization Budget Current Fiscal Year IT Budget Primary Sources of Funding Limit 600 characters with spaces. Geography Served Limit 600 characters with spaces. Services the Nonprofit Provides Limit 600 characters with spaces. Number of People Served Last Calendar Year Limit 600 characters with spaces. PART III: APPLICATION What is the current state of your technology? Limit 1000 characters with spaces.Please include information such as who looks after your computers and troubleshoots application issues; do you have any full-time dedicated IT staff; do you have applications in place to manage email, finances, payroll, or other functional areas; are they cloud-based solutions or do they sit on one computer/server within your office. How could technology improvements impact your organization and your mission? Limit 1000 characters with spaces.