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* 1. Name of Organization

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* 2. Which of the following counties does your organization serve? Check all that apply.

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* 3. How many people will be served by your organization through the General Operating grant?

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* 4. Describe the racial and ethnic makeup of the individuals your organization serves each year:

  Hispanic / Latinx / Latina/o Black / African-American Caucasian Asian Native American Native Hawaiian or Other Pacific Islander Other
Percent Served

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* 5. What is the gender identity of individuals served by your organization annually?

  % Cis-Women % Cis-Men % Gender Non-Conforming / Non-binary Trans-Men Trans-Women
Percent Served

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* 6. What primary population does your program serve?

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* 7. What percentage of those served by your agency or this initiative would be considered of low-to-moderate income?

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* 8. Which of WOMEN’S WAY’s four pillars does your organization’s programming address? (Check all that apply.)

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* 9. Is the organization led by (Executive Director or Board Chair) a woman of color?

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* 10. Were your organization's last fiscal year revenues under $500,000?

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* 11. What were your organization's revenues for the last fiscal year?

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* 12. What were your organization's expenses for the last fiscal year?

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