SAMPLE SeaChange Inquiry Form (NOT LIVE)

Thank you for your interest in SeaChange. This form is intended to collect information that will make our first conversation more productive.

If you are applying for a grant to support a merger or collaboration then BOTH organizations must fill in the form.

Please feel free to reach out to us at any time at info@seachangecap.org if you'd like to discuss your situation directly before completing the form.

Please note: for inquiries related to higher education, please use our higher education form instead.

FOR THIS SAMPLE FORM, YOU MUST SELECT A RESPONSE FOR 'What are you interested in?' UNDER THE 'Nature of Inquiry' SECTION IN ORDER TO PREVIEW THE REST OF THE APPLICATION.

Contact Information

Last Name

First Name

Email

Phone Number

Use format ###-###-####

Title

Organization

Website

Nature of Inquiry

If you are interested in a grant or loan but have not yet had a conversation with the SeaChange team, we encourage you to select "Learning more about SeaChange or its funds." or to reach out to info@seachangecap.org. We are happy to discuss your situation and our funding process prior to you completing the full grant or loan application, and want to be mindful of the time and effort you spend on our form before receiving all available information.

What are you interested in?

Please elaborate on the situation and how you think SeaChange might be able to help.

How did you learn about SeaChange?

Please explain:

Organization Information

Contact Information

Last Name

First Name

Email

Title

Phone Number

Use format ###-###-####

Is the primary contact also the Executive Director / CEO?

Executive Director

Last Name

First Name

Phone

Email

Title

Organization

Street Address

Town/City

State

Zipcode

Legal Status:

EIN

Use format ##-#######

Please briefly describe the organization's mission and core programs/services.

Contact and Organization Information (Organization Two)

Contact Information

Last Name

First Name

Email

Title

Phone Number

Use format ###-###-####

Is the primary contact also the Executive Director / CEO?

Executive Director

Last Name

First Name

Phone

Email

Title

Organization Information

Organization

Website

Street Address

Town/City

State

Zipcode

Legal Status:

EIN

Use format ##-#######

Please briefly describe the organization's mission and core programs/services.

Loan Application: Loan Information

What type of loan are you seeking?

Please briefly describe how you will use the proceeds of the loan?

What is the total amount of the loan that you are seeking?

How long do you expect to need the funds?

How will you repay the loan?

Please explain what conversations you have had with traditional lenders (e.g. banks or CDFIs). Why is the loan not easily financed by these lenders?

What will the funds allow you to do in terms of program impact and how will this be measured?

Is the board aware that you are seeking a loan?

Board Member

Merger and Sustainable Collaboration Application: Process Status

Please very briefly explain the potential collaboration and the current status of the process

What is the status of the collaboration?

If this survey is not being filled out by one of the contacts please briefly explain who you are and what role you are playing in the proposed collaboration

What best describes the type of collaboration you are proposing?

How long ago did discussions begin?

Who first initiated discussions

Is this the first time the organizations have been in discussions?

If a Memorandum of Understanding (MOU), Term Sheet, or similar document has been signed b the organizations, please attach it:

What are the principal benefits of the proposed collaboration?

What are the principal risks associated with the proposed collaboration?

Have you estimated the one-time costs associated with exploring or completing the collaboration?

Please attach a spreadsheet with a a breakdown of the estimated costs and note any which have already been paid.

Merger and Sustainable Collaboration Application: Process (continued)

In addition to a possible grant from from SeaChange or its affiliated funds, how do you expect that the costs will be covered?

Funding from one or more of the organizationsNew Support from Existing FundersSupport from New Funders

Have other funders been approached for support

If yes, please provide a list of potential and committed funders and their actual/expected levels of support

Has a consultant/mediator/facilitator been engaged in the process?

Please explain who retained (or expect to retrain) and the process by which they were selected

If you have signed (or expect to sign) an engagement letter, please attach it

Consulting Inquiry

What best describes your consulting need?

Please describe the situation that you face and how you believe SeaChange may be able to help.

Please rest assured that all information collected by SeaChange will be treated confidentially.

Please attached any files that you think would be helpful for us in understanding your situation?

Thanks for your interest

We take confidentiality very seriously. However, in order to move forward with a grant or loan we will need to seek approval from certain of our funding partners. Do we have your permission to share your information with our funders at this time?

We strive to be respectful of the scarce time of our potential nonprofit partners. How long did this form take you to complete?

Do you have any comments on what would make it more helpful?