Wufoo

Community Economic Development Law Project

100 N. LaSalle Street, Suite 600 - Chicago, Illinois 60602
Phone: (312) 939-3638 - Fax: (312) 630-1127 - Email: jadler@cedlp.org

NONPROFIT LEGAL ASSESSMENT INTAKE FORM

A legal assessment is a comprehensive review of your organization’s legal documents, including its Articles of Incorporation, bylaws, leases, contracts, personnel policies and insurance policies. To begin the legal assessment, complete this form and return it to CEDLP. If you don’t know or can’t find the answer to a question or are unable to locate the information, please indicate that in your response. There are no wrong answers. If you have questions about this form or the program, call or email Jody Adler, the program director. Upon receipt, Jody will review the information and contact you to discuss the next steps.

FEE: CEDLP requires a $100.00 application fee in order to process your request. (If an organization is unable to pay this fee, please contact Susan Kaplan).

PLEASE NOTE: IF YOU ARE COMPLETING THIS FORM TO SUBMIT ONLINE, YOU WILL NOT BE ABLE TO SAVE THE FORM AND THEN RETURN TO COMPLETE IT. BEFORE BEGINNING, YOU SHOULD REVIEW THE FORM, GATHER THE NECESSARY INFORMATION AND THEN COMPLETE IT.
PART I. GENERAL INFORMATION
Organization Name: *
Organization Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

**You must complete each field. If the field doesn't apply type n/a.
Organization Phone: ### - ### - ####
Organization Fax: ### - ### - ####
Organization Web Address:
Organization Email:
Staff Contact: * First Last
Contact Title: *
Contact Phone Number: ### - ### - ####
Contact Fax Number: ### - ### - ####
Contact Email:
Board Contact: * First Last
Board Title: *
Board Phone Number: * ### - ### - ####
Board Fax Number: ### - ### - ####
Board Contact Email:
PART II. STATISTICAL INFORMATION

CEDLP is a not-for-profit service organization that is dependent on funding from government, corporate and private sources. Without this support, the CEDLP would not be able to provide you with legal advice and representation. To apply for funding, we must supply statistics on our clients.
Does your organization specifically service one or more of the following constituencies?
Native American African American Latino/Hispanic Asian White Disabled Women Homeless Unemployed Elderly Gender/Sexual Orientation Other: Please use space below to identify
Does your organization specifically service one or more of the following age groups?
Under 18 60 & Over
Does the organization’s work focus on a specific neighborhood or community? Identify the community (ies)
PART III. INITIAL DOCUMENT REQUEST

Submit the following documents. If you are unfamiliar with any of them, cannot find them or are unsure if they exist, please let us know. This will not jeopardize the intake process. You can email the documents to jadler@cedlp.org, mail them with the application or fax them.

A.Organization (The person who does proposal writing in your office may know what or where these documents are.)
1. Articles of Incorporation and any amendments
Attach a File
2. Bylaws and any amendments
Attach a File
3. Tax exemption application (1023)
Attach a File
4. Determination letter from the IRS (This is the letter that grants the organization recognition of income tax exemption)
Attach a File
B.Employment (If there is an human resources person or department, they will have these documents. If not, the Executive Director should know where they are. )
1. Personnel policy or employment policy
Attach a File
2. Corporate structure chart showing number of employees and independent contractors.
C. Board of Directors (The Executive Director, the President or Secretary of the Board should know where these documents are.)
1. List of all current board members, with addresses, email and phone *
Attach a File
2. Conflict of interest policy
Attach a File
PART IV. ORGANIZATION SPECIFICS

A. Mission and Main Activities of Organization - Attach a statement of the organization’s mission and its main activities or printed material that includes its mission and main activities or the link to the online location of this information.
B. If there is an attorney(s) who has worked with the organization in the past that you would like us to contact to assist with this project, please list their name (s):
C. In addition to general legal assistance, is there a specific legal issue that needs to be addressed during this assessment.
Leases Contracts Employment Intellectual property Governance (board issues) Compliance with tax exemption matters Fiscal Other (attach a statement of the issues).
Attach a File
BY SIGNING THIS FORM YOU AGREE THAT THE INFORMATION YOU PROVIDED AND WILL PROVIDE TO CEDLP MAY BE DISCLOSED TO ATTORNEY/VOLUNTEERS, LAW FIRMS AND LEGAL DEPARTMENTS AT CORPORATIONS IN OUR EFFORTS TO RECRUIT PRO BONO ASSISTANCE FOR YOUR ORGANIZATION. THIS INFORMATION IS SUBJECT TO THE ATTORNEY-CLIENT PRIVILEGE. ALSO YOU AGREE THAT CEDLP MAY DISCLOSE THE ORGANIZATION’S NAME TO OUR FUNDERS. WE WILL NOT SHARE THE NATURE OF YOUR REQUEST.
SIGNATURE: * First Last
TITLE:
Date MM / DD / YYYY
RETURN TO: CEDLP, 100 N. LaSalle Street, Suite 600, Chicago, Illinois, 60602. If you submit this form and attachments electronically, PLEASE SUBMIT THE APPLICATION FEE VIA MAIL.
NOTE: *
Before submitting, please make a copy of this application for your records.
Do Not Fill This Out

Wufoo

Community Economic Development Law Project

NONPROFIT LEGAL ASSESSMENT INTAKE FORM

PART I. GENERAL INFORMATION

PART II. STATISTICAL INFORMATION

PART III. INITIAL DOCUMENT REQUEST

PART IV. ORGANIZATION SPECIFICS

RETURN TO: CEDLP, 100 N. LaSalle Street, Suite 600, Chicago, Illinois, 60602. If you submit this form and attachments electronically, PLEASE SUBMIT THE APPLICATION FEE VIA MAIL.