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  1. Home
  2. Non-Profit Application Form

Non-Profit Application Form

Non-Profit Application Formsarahfiverr2023-09-14T17:27:09-04:00
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General Information

Mailing Address
Is the Physical address is different than Mailing Address?
Physical Address
Can we text you?

Services

Do you offer any of the following services?
Please Select
Do you have any special events planned for the next 12 months?

Current Insurance

Do you currently have insurance?
MM slash DD slash YYYY
Have you had any claims in the last five years?
Do you currently have Professional Liability coverage?
MM slash DD slash YYYY
Do you currently have Abuse and Molestation coverage?
MM slash DD slash YYYY

Property

Physical address Building description: Year built Total building square footage Total building square footage Roof type Last year improvements were made to Heating source? Basement? % Finished % Unfinished Number of stories Distance from Fire Station Distance from Fire Hydrant Type of alarm Sprinkler system? Actions
                               
There are no Entries.

Maximum number of entries reached.

Do you own or have on premises any of the following?

Financials

Does you keep more than $5,000 in cash on premises at any time?
Is the organization more than 25% owned by a private equity fund structure?
Does the organization offer any of the following?
Plan Name Year Established Assets/Contributions Participants Administrator Actions
         
There are no Entries.

Maximum number of entries reached.

Plan Name Year Established Assets/Contributions Participants Administrator Actions
         
There are no Entries.

Maximum number of entries reached.

Plan Name Year Established Assets/Contributions Participants Administrator Actions
         
There are no Entries.

Maximum number of entries reached.

Plan Name Year Established Assets/Contributions Participants Administrator Actions
         
There are no Entries.

Maximum number of entries reached.

Staff and Volunteers

Position Description Class Code # of Employees – FT or PT # of Contracted – FT or PT Volunteer Hours Annual Payroll Actions
           
There are no Entries.

Maximum number of entries reached.

Please enter a number greater than or equal to 0.
Does your employment process include verification of whether the individual has ever been convicted of any crime, including sex related or child-abuse related offenses, before an offer of employment is made?
Do you have a written crisis plan in place?
Do you have an employee handbook?
Is there formal staff training for volunteers and staff on child/sexual abuse, including how to recognize the signs?
Are there procedures prohibiting closed door one-on-one meetings / counseling?
Have any incidents resulted in an allegation of sexual abuse or workplace violence?
Was the case settled?
Was the case taken to trial?
Amount paid for damages to the victim?

Special Events

What type of event? Other type of event Date(s) of the event Hours of operation Total anticipated revenue Held on your premises? Address of where it is being held Number of participants Number of staff members / volunteers needed Are certificates of insurance obtained from everyone providing products / services? Do participants sign a waiver? Will you be offering/selling alcohol? Actions
                       
There are no Entries.

Maximum number of entries reached.

Transportation

Does the organization own any vehicles?
Do you require employees and volunteers to carry and show evidence of personal insurance?
Do you have a driver safety program?
Do you transport clients?
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CTG Insurance

10751 S Saginaw St Suite A
Grand Blanc, Michigan 48439
Phone: 800-732-0096
Secondary phone: 810-695-0096

CTG Insurance
P.O. Box 8
Grand Blanc, MI 48480

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