Date:
Name of Organization:
Street Address:
City:
State:
Zip:
County:
Contact Person:
Title:
Daytime Phone:
Fax:
Email: *Required	(Ex: email@yoursite.com)
Organization Mission:
Employees:
Independent Contractors:
Agency Status:
501(c)(3) 501(c)(4) Other: Advanced Ruling Permanent Application
Incorporation Date:
Fiscal Year End:
Current Year Budget:
The organization's total contributions from the past year?
Have you had a compilation, review, or audit? If so, when?
Do you currently have a person providing bookkeeping/accounting services?
The contact person in the organization to be trained by Community Accountant's volunteer?
Name:
Phone Number:
Have you ever used Community Accountant's services before?
When?
What services did you receive?
Please indicate the areas of concern for your organization: Review current bookkeeping system of receipts and disbursements Procedure for documenting receipts and disbursements Recommend/instruct/set-up computerized accounting systems (QuickBooks, Peachtree, etc.) Review and provide recommendations to establish accounting and internal control procedures Training on preparation of bank reconciliation's preparation. Set-up/instruct on payroll system (CA Volunteers do not complete tax returns) Answer questions about payroll and tax reporting responsibility Explain Federal and State reporting requirements Assist with budgeting Assist/review financial information for the 501(c)(3) application (form 1023) Assist with an understanding of the preparation of financial statements (CA Volunteers do not prepare financial statements) Recommendations for preparing for audit or review (CA Volunteers do not perform audits, reviews or compilations) Other:
Please enclose any information relevant to your organization, i.e. programs and list of board of directors. Include newsletter, brochures, annual report, news releases, flyers, written descriptions, etc.
How did you hear about Community Accountants? Radio/TV Referral by: Newspaper Press Web site Other: