Nonprofit Formation Intake — Scale With Michelle

Where Are You Organizing?

Pick the state where you will file your Articles of Incorporation.

City where organizing

State where organizing

Organization Basics

Founder full name

Founder email

Founder phone

Proposed legal name — 1st choice

Proposed legal name — 2nd choice

Proposed legal name — 3rd choice

Entity type

Nonprofit Corporation Other

Corporate designator preference

Inc. / NFP / Corporation / No preference — use what filing requires

Principal office — full street address

Street, city, state, ZIP

Mailing address, if different

Organization phone

Organization email

Website (if any)

Fiscal year end (month / day)

Common choice: December 31. This drives every future filing deadline.

Date the organization should legally exist

Or write "as soon as filed"

For-profit practice (legal name)

Registered Agent

Every state requires a registered agent with an in-state address. Your state’s exact rule appears below.

Registered agent — full name

Registered office — street address

Has the agent agreed to serve?

Yes No — agreement still needed

Board of Directors

Your state requires at least 3 directors. For IRS purposes, aim for a board in which a majority are independent — not the founder, not family of the founder, and not owners or employees of the for-profit practice.

Director 1

Director 1 — full legal name

Director 1 — home address

Director 1 — phone

Director 1 — email

Director 1 — board role / title, if known

Director 1 — relationship to the for-profit practice

Owner Employee Family Independent

Your state requires at least 3 directors.

Do you have at least 3 independent directors identified?

Yes — I have at least 3 independent directors identified No — recruiting is still needed

Who still needs to be recruited, and by when?

Officers

The Secretary and the Treasurer should ideally be independent directors. One person may not hold every office.

President / CEO

Secretary

Treasurer

Vice President name

Other officer — title and name, if any

Will this be a membership organization?

Yes No

If yes, describe who the members are and what rights they have

Mission, Vision & Programs

This section becomes the narrative at the heart of Form 1023. Answer in your own words, in as much detail as you can — specifics here prevent follow-up questions later.

Mission statement — what the organization exists to do

Vision statement — the change you want to see in the community

Programs and services — describe each one

What services, how they are delivered (in person, virtual, group, individual), where, and how often.

Who exactly will be served? Describe the underserved communities

Who they are, where they live, and what need they face.

How will the nonprofit find and reach these communities?

Referrals, community partners, outreach, waitlists from the practice, other.

Will services be free, sliding-scale, or fee-based? Describe

Who pays, how fees are set, and what happens if someone cannot pay.

Programs planned for the future that will not start in year one

Describe each and when it might start.

Business Plan

These answers become the vision, objectives, strategies, and action plan in your business plan document. Answer what you can — every field is optional.

Vision

The future you are working toward — paint the picture of what success looks like.

Vision point 1

Vision point 2

Vision point 3

Vision point 4

Objectives

Measurable goals — what will the organization accomplish?

Objective 1

Objective 2

Objective 3

Strategies

Your approach — how will you get there?

Strategy 1

Strategy 2

Action Plan

Concrete first steps and when they will happen.

Action plan year range

Action item 1

Action item 2

Action item 3

Action item 4

Financial Picture

These figures determine whether the organization files the full Form 1023 or Form 1023-EZ, and they are required on the application itself. Use your best good-faith estimates.

Expected gross receipts — Year 1

Expected gross receipts — Year 2

Expected gross receipts — Year 3

Expected total assets at any point

Based on the figures above

Form 1023-EZ is available only if expected gross receipts are $50,000 or less in each year AND total assets are $250,000 or less. If either figure is higher, the full Form 1023 is required.

Likely 1023 Full Likely 1023-EZ Unclear

Expected funding sources

Other funding source — describe

Will the nonprofit pay anyone compensation in year one? If yes, who and in what role?

Amounts are set later.

Startup funding — how will filing fees and initial costs be covered?

Fundraising Plans

Most states require charitable solicitation registration before you ask for donations. Your state’s rule appears below.

Will the nonprofit solicit donations in its home state in year one?

Yes No

Fundraising methods planned

Other fundraising method — describe

Will any paid fundraiser or fundraising consultant be used?

No Yes

Paid fundraiser / consultant name

Will the organization solicit donations or fundraise in any state other than its home state?

Yes No

If yes, list each state

Most states require charitable solicitation registration before fundraising begins there.

Will the organization conduct any lobbying activities?

Yes No

If yes, describe the lobbying activities

Will the organization participate in any political campaign activity for or against any candidate?

501(c)(3) organizations are prohibited from political campaign activity.

Yes No

Relationship With the For-Profit

Needed for the shared services agreement and for the Form 1023 narrative. The nonprofit is a separate legal entity, created by the for-profit's founder as an extension of its mission to serve underserved communities.

Will the nonprofit share office space with the practice?

No Yes

If yes — address and approximate square footage

Will any staff work for both entities?

No Yes

If yes — which roles?

Will the practice provide any services to the nonprofit? Describe

Billing, administration, IT, clinical supervision, other.

Will the nonprofit refer clients to the practice, or the practice to the nonprofit? Describe

How referrals would work in each direction.

Founder initials — shared arrangements in writing at fair market value

Type your initials to confirm: every shared arrangement — space, staff, and services — must be in writing at fair market value.

Incorporator

The incorporator signs the Articles of Incorporation. This is usually the founder or her attorney.

Incorporator — full legal name

Incorporator — address

Incorporator — phone

Incorporator — email

Organizational Meeting

These details go straight into your organizational board meeting minutes and bylaws. Answer what you can — every field is optional.

Date of organizational board meeting

Meeting time

Members present at organizational meeting

How often will the board meet?

Regular meeting day

Director term length

Who will pay the filing fees?

Who will cover business supply expenses?

Follow-Up & Next Steps

Please review every section before submitting. Anything left blank will require a follow-up before a filing can be prepared.

Best contact for follow-up questions

Name, phone, email, best time / method.

Anything else you want your consultant to know

Where Are You Organizing?

Organization Basics

Registered Agent

Board of Directors

Officers

Mission, Vision & Programs

Business Plan

Financial Picture

Fundraising Plans

Relationship With the For-Profit

Incorporator

Organizational Meeting

Follow-Up & Next Steps

Intake form received