Pittsburgh Community Reinvestment Group Membership Application

ORGANIZATION INFORMATION

Organization’s Contact Information Name: (What is the legal name of your organization and standardly used acronym, if applicable)?

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Address (If different than mailing address)

Phone

(###)

###

####

Website

http://

Facebook and or Twitter handles :

Nonprofit Category (Please indicate your nonprofit tax exempt status, i.e: 501(c)(3), 501(c)(4), or 501(c)(6) and email or mail your certification letter.)

Year Incorporated

Organization's Composition

If self-appointed, is your board composed of:

Residents

Businesses

N/A

Other

If you answered "Other" above, please explain here:

Annual Budget

Number of Paid Staff * (This can include staff paid via another entity, part-time staff, interns, etc.)

Number of Full-time Staff (Of these, indicate how many are full-time with benefits.)

PURPOSE

Organization's Mission Statement

Area Served What is the geographic boundary and/or focus of your organization?

Does your organization have a comprehensive or strategic plan?

Yes

Other

What are your organization's primary business purposes?

If you answered "Other" above, please explain here:

List three of your most important organizational priorities.

Describe up to three of your most relevant and current projects or initiatives. Please only include work within Allegheny County.

NEXT STEPS

Membership Dues Structure Membership to PCRG is for a single calendar year. Dues are designed at the lowest responsible fee structure and are tiered based on member group's asset size. Please identify which tier you fall into and prepare a check made payable to 'PCRG' for the corresponding amount. Mail the check and a copy of your current budget to the PCRG offices at the address at the beginning of this application. If more convenient, you may email a copy of your operating budget to: ehogan@pcrg.org and cc pghcrg@gmail.com.

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