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Impact & Coffee Application to Present
Impact & Coffee takes place the first three Tuesdays of the month at 9am. It is an event focused at bringing together the nonprofit community to support people doing great things. It's a six minute talk focused on your story - your successes, failures, why you do what you do and what you've learned along the way.


As a speaker we ask you to consider the follow three points as a focus for your presentation:

1. Tell us your story, what brings you to your work?
2. What is your IMPACT? Describe the kind of effect or influence your project/organization has/will have that is
transformative in the community?
3. How are you INNOVATIVE? Describe the uniqueness of your project's/organization's approach that other non-profits
could benefit from?

First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Your role in the organization? *
Your answer
Mailing Address (we'd like to send you a thank you card!) *
Address, city, state, zip code
Your answer
In the event you have an emergency and are unable to make your presentation, is there someone else at your organization that can cover for you? *
Please provide the contact name, email and phone number of your back-up. *
Your answer
Company Name *
Your answer
Description of the organization *
Your answer
One sentence description of the organization *
Your answer
When was this effort founded?
Your answer
Focus area *
Ex. Education, Health, Fundraising, Economic Development, Arts/culture, Social Services, Capacity building, etc
Your answer
Organization's stage of growth *
Are you a Non-Profit? *
Location *
Street, City, State, Zip
Your answer
Your Story
How are you impacting the local community in a new and unique way?
Your answer
Why do you do this work?
Your answer
What have you learned in the course of doing this work?
Tell us about your challenges, your struggles, and what you've learned.
Your answer
How do you see this effort's impact growing in the future?
Your answer
What can we as a community do to help you succeed?
Do you need ideas, validation, funding, volunteers, expertise, etc?
Your answer
Have you attended Impact and Coffee previously? *
Social Media
Website
Your answer
Facebook
Your answer
LinkedIn
Your answer
Twitter
Your answer
Pinterest
Your answer
YouTube
Your answer
Can Impact & Coffee use your image for promotional purposes? *
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