VSA Arts of Georgia

Georgia Community Support & Solutions

Community Events Application for Services

July 2020 - June 2021


Mailing Address *
Mailing Address
http://
Staff Contact at Agency *
Staff Contact at Agency
Person who will handle ticket requests.
Phone *
Phone
All information must be completed and returned for continued service. Please fill out completely - our funders require this information.
Areas of Service *
Check all that apply
Other Area of Service not listed above.
Briefly state the general purpose & goals of your agency.
Describe specific programming & services provided.
How do individuals become eligible for your programs & services?
How long do you typically maintain contact with each client?
How many clients does your agency serve annually?
Date you began providing services in the State of Georgia:
Non-profit agencies MUST submit a copy of your most recent IRS Form 990, documenting your annual budget. If your annual budget does not meet the requirements for IRS Form 990 (if your annual budget is less than $25,000), you must submit a copy of your current annual budget. Government agencies just send annual budget.
Indicate % of funding from each source:
Demographic Info – Our donors require this information from us.
Information Source: Agency Data Of the total number of people served each year, what percent are:
(maximum $24,250/year for a family of 4)
(maximum $29,100/year for a family of 4)
Agency Certification
We certify that the information included in this agency update is true and complete to the best of our knowledge.
Agency Director *
Agency Director
Agency Director *
Date *
Date
Phone *
Phone
Staff Contact at Agency *
Staff Contact at Agency
Staff Contact *
Date *
Date
Phone *
Phone