Organization Name: * Mailing Address: * City: * State: * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: * Site Address (if different): City: State: - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Executive Director: Work Phone: Email: Board Chairperson: Work Phone: Email: Project Coordinator: * Work Phone: * Email: * Website: Your organization's annual budget: How many people do you have on staff: Do you have a budget for this project? If so, how much: * Does your organization have IRS 501(c)(3) status?: * Yes No If not, does the organization have a fiscal sponsor with 501(c)(3) status?: Yes No IRS Tax ID Number: * Briefly describe the mission and work of your organization, the community and individuals you serve & the services you provide: Please provide a short description of the event or program you are seeking production assistance for: If you want assistance producing a program in MNN's studio: Describe the program format, ie, "talking heads," performance etc.: How many guests or participants will be involved: Do you want to go live and take phone calls from the audience:: If you want assistance producing a program at a location other than MNN: Describe the location where the program will take place. What is the address:: What is the address: How many participants: What time will the event take place: Indicate the frequency (one time only, weekly, bi-weekly or monthly) of programs you want to produce: Provide a brief outline of each program you plan to produce, include the working title, length, topic/storyline, guests, etc.: Outline the specific needs to be addressed by this project, your overall objectives and goals: Who is the audience you are trying to reach? How will you promote and publicize the program?: What methods will you use to develop an audience for your programs?: You must attach one copy of each of the following Recent brochure or newsletter (or description of your organization on official letterhead): List of organization's Board of Directors: IRS Letter of 501(c)(3) determination: Brochure or flyer detailing event or project to be taped:
