Nonprofit Application for Pro Bono Services

Complete this application if the nonprofit organization has not previously submitted an application to CORP. In order to be eligible for pro bono assistance, the nonprofit must (1) with a few exceptions, be located in Northern California; (2) provide direct service to Bay Area low-income or underserved individuals; (3) be seeking transactional (i.e. non-litigation) legal assistance, and; (4) demonstrate the inability to pay for legal services without significantly impacting resources for programs.

Please complete and submit the application form and the survey form. You can upload the required documents, listed at the end of the application form, below. Thank you.

"*" indicates required fields

Organization Contact Information

Name of Organization:

Street address:

Street Address City State ZIP Code

Phone

Website address:

Leadership Contact People

(two leadership-level persons)

Contact Name:

First Middle Last

Position/Title:

Phone:

Email:*

*A copy of your submitted application will be sent to your email shortly.

Second Contact Name:

First Middle Last

Second Contact Position/Title:

Second Contact Phone:

Second Contact Email:

Mission Statement Summary

(1-2 sentence summary)

Mission Statement Summary

Direct Service Provided

(Describe the direct services you provide to low-income or underrepresented individuals.)

Direct Service Provided

Percentage of Low Income Individuals Served

Of the people you do or will serve, please estimate what percentage are low income or live at 125% or more below the federal poverty level?

Type the percentage

Bay Area Counties the Organization Serve

(Please select all that apply)

Bay Area Counties the Organization Serve

Alameda

Contra Costa

Marin

Napa

San Francisco

San Mateo

Santa Clara

Solano

Sonoma

Other:

Bay Area Counties the Organization Serve:

Organization Details

Employer Identification Number (EIN):

Annual Operating Budget:

Does the budget include a line item for legal fees?

Yes

Total projected revenue for the current fiscal year:

Is the organization incorporated as a nonprofit?*

Yes (If yes, include date and state.)

Date*

State*

State

Does the organization have IRS tax-exempt status?*

Yes (If yes, include date.)

Date*

If organization does not have IRS tax-exempt status, has it applied for it?*

Yes (If yes, include date.)

Date*

Explain the legal assistance your organization seeks

Are there any deadlines or time constraints related to the requested legal help? Please explain.

Please attach a copy of the documents listed below, as well as any documents/correspondence related to the legal matter:

• Articles of Incorporation
• Bylaws
• List of Board of Directors and their employers
• Most recent IRS Form 990, 990-EZ, or 990-N
• Income and expense budget for the current year
• Most recent audit (if available)
• Potential and actual conflicts list (please list individuals and/or organizations that are or may be involved in the legal issue(s)

File

Drop files here or

Max. file size: 50 MB.

Submission Agreement:*

I declare under the penalty of perjury that the information I have provided is true and correct to the best of my knowledge.

Signature*

First Last

Date*

MM slash DD slash YYYY

CORP Application Survey

1. How did you learn about CORP?

Website

LRIS

BASF Bulletin

BASF Member

BASF Staff

Another Nonprofit

Other (Please specify)

1. How did you learn about CORP?

2. Please indicate the percentage of the organization’s leadership (i.e., Executive Director, board members) that identify with the following racial groups.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White or Caucasian

Other (Please specify)

3. Number of full-time employees:

0-5

6-10

11-20

21+

4. Number of part-time employees:

0-5

6-10

11-20

21+

5. Number of independent contractors:

0-5

6-10

11-20

21+

6. Number of volunteers:

0-5

6-10

11-20

21+

7. How many clients/individuals do you serve annually?

Last year’s total:

8. Which San Francisco neighborhoods does the organization serve? (Check all the boxes that apply)

Fisherman’s Wharf/North Beach

Chinatown

Nob Hill

SOMA/Tenderloin/Yerba Buena

Presidio/Richmond

Marina/Pacific Heights

Western Addition/Haight-Ashbury

Castro/Noe Valley

Outer Mission/Excelsior

Bayview/Hunters Point

Civic Center/Hayes Valley

Sunset

Mission District

Other:

8. Which San Francisco neighborhoods does the organization serve? (Check all the boxes that apply)

9. What percentages of your clients are deemed low income?

Low income can be defined as receiving public benefits, like Medi-Cal, Food Stamps (CalFresh), Cal-Works, General Assistance, SSI, SSP, Tribal TANF, IHHS or CAPI or if your client’s gross monthly income (before deductions for taxes) is less than the amount within this table.

10. What percentage of individuals /clients are unhoused?

11. What percentage of individuals / clients have limited English proficiency?

12. What percentage of individuals /clients are unemployed?

13. What percentage of individuals /clients are immigrants?

14. What percentage of individuals /clients are disabled?

15. Gender: What percentage of individuals /clients identify with the following gender identities:

Male

Female

Transgender

Non-binary/gender non-conforming

Prefer not to say

16. Race/Ethnicity: What percentage of your clients identify with the following ethnic groups:

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

White or Caucasian

Native Hawaiian or other Pacific Islander

Other (Please specify)

17. Age: Indicate the percentage for the following client age grouping:

Up to 17 years old

18-30 years old

31-44 years old

45-64 years old

65 years old and over

Prefer not to answer

18. Nonprofit organization description of services:

Check the ONE description that best describes the services provided by your organization

After-school programs

Animal Related

Arts, Culture & Humanities

Asylum legal

Childcare / family support

Community Improvement & Capacity Building

Disability

Domestic violence

Education

Employment

Environment

Financial literacy

Food, Agriculture & Nutrition

Foster care related

Health Care

Housing & Shelter

Immigration

LGBTQ Services/Advocacy

Mental Health & Crisis Intervention

Public Safety, Disaster Preparedness & Relief

Recreation & Sports

Reentry, during or after incarceration

Science & Technology

Senior/ elderly legal

Social/Well being

Youth Development

Other

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