NEW MEMBER APPLICATION
Primary Contact Information
First Name
MI
Last Name
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Email
Organization Information
Please select your organization's annual operation budget
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Under $50,000
$50,000 - $99,999
$100,000 - $249,999
$250,000 - $499,999
$500,000 - $999,999
$1,000,000 - $2,499,999
$2,500,000 - $4,999,999
$5,000,000 - $7,499,999
$7,500,000 or higher
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Notes
Mission
500 words remaining
Services
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Advocacy
Arts
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Children
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Geographic Area
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Immigrant Communities Served
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MENASA (Middle East/North African)
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Languages Spoken by Staff
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Immigrant attorney on staff
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No
DOJ-accredited rep on staff
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No
Accept referrals
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Expectations of membership in the NYIC
Additional Information
Organization Reference
Organization Name
Contact Name
Phone
Email
Upload of 501(c)3 tax exempt letter (or Fiscal Sponsorship letter)