Name *

First Name

Last Name

Phone *

(###)

###

####

Existing Contact Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Type of organization *

(select more than one if applicable)

Government

Nonprofit

Business

Faith-based

Other

What are your organization funding sources? *

Foundation

Other

Does the organization have 501(c)3 status? *

Yes

No

Pending Status

How often does the board meet? *

Monthly

Quarterly

Other

*

We have read the project guidelines

We understand that as part of the process of selecting this year's projects, MCLP may require finalists to meet the committee in person or by phone to answer questions.

We understand the MCLP vision is "Leadership which fosters a thriving, inclusive world." We commit to partnering with the MCLP on a project which respects the MCLP values of Servant Leadership, Self-Awareness, Diversity Inclusion, Integrity, Excellence, Social Justice, and Community Action.