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Indiana Association of Public Education Foundations P.O. Box 1124 Carmel, Indiana 46082-1124 (317) 582-0590 Membership Application Name of Foundation __________________________________________________________________ Name of Board President ___________________________________ Phone_____________________ Name of Executive Director _________________________________ Phone_____________________ Foundation Address ___________________________________________________________________ City/State/Zip ________________________________________________________________________ Fax _____________________________________ E-mail Address _______________________________________________________________________ Main Contact _______________________________ Position __________________________________ Mission Statement ____________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Has your organization been incorporated?________________ Incorporation/Founding Date ____________ Do you have or have you applied for 501(c)3 status? _____ Yes _____ No Board _____Yes _____No Number of Board Members _____ Staffing Volunteer run _____ Hours worked per week _____ Part-time Paid Staff _____ Hours worked per week _____ Full-time Paid Staff _____ Hours worked per week _____ Date when paid staff position was initiated _____ Annual Salary Range _____$0 - $5,000 ______$5,001-$10,000 _____$10,001-$15,000 _____$15,001-$20,000 _____$20,001-$25,000 _____over $25,000 Foundation Description _____Rural _____Suburban _____City _____County-Wide _____One School Corporation _____Multi-School Corporations; how many? ______ Name of School Corporation___________________________________________________ Superintendent Name______________________________________ Phone_____________________ School Corp. Address _________________________________________________________________ City/State/Zip ________________________________________________________________________ Student Population Served _____less than 1,000 _____1,001-2,500 _____2,501-5,000 _____5,001-7,500 _____7,501-10,000 _____10,001-15,000 _____over 15,000 How does your organization raise funds?__________________________________________________ ___________________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Program Description List the primary services/activities provided by your foundation each year (i.e., awarding of grants, teacher recognition, scholarships, etc.) 1. Name of Activity ____________________________________________________________________ Description ________________________________________________________________________ __________________________________________________________________________________ 2. Name of Activity ____________________________________________________________________ Description ________________________________________________________________________ __________________________________________________________________________________ 3. Name of Activity ____________________________________________________________________ Description ________________________________________________________________________ __________________________________________________________________________________ 4. Name of Activity ____________________________________________________________________ Description ________________________________________________________________________ __________________________________________________________________________________ 5. Name of Activity ____________________________________________________________________ Description ________________________________________________________________________ __________________________________________________________________________________ Volunteer Opportunities IN-APEF has a variety of opportunities for members to volunteer. Let us know if we can call you for help in any of the following areas: ¨Board of Directors ¨Fundraising Committee ¨Programs Committee ¨Conference Committee ¨Membership Committee ¨Nominations Committee Membership Dues Foundations with a paid executive director and a member of INAPEF more than 3 years $300.00/year Foundations with a paid executive director and member of INAPEF 3 years or less $150.00/year Foundations without a paid executive director $75.00/year
Please return this form with your check to P.O. Box 1124
Carmel, Indiana 46082-1124. Thank You! |