Plantory Member Application
Date
Type of membership
Number of Desks Requested
Name of Organization/Project
Current Address
Contact Person
Telephone #1
Telephone #2
Email
Website
Facebook
Organizational Information
Additional Members Sharing the Space, phone numbers, email
Organization's FEIN - Federal Identification Number
Organization's KY SOS - Ky State Organizational Number
When was the Organization/Project started?
Mission
What makes your work socially innovative or important?
What is the target demographic/population for your programs and projects?
Organization Sector
Stage of the Organization
Organization Type:
Legal Structure
Statistical Information
Staff Size
Average Total Weekly Hours of Desk Use
(for entire staff)
Volunteer Staff
Average Total Weekly Hours of Desk Use
(for volunteer staff)
Please tell us about your current programs and projects.
# of people served through your programs and projects
Recent Grants Applied for and Received
Since the program/project start date, please explain any applicable organizational changes (expansion, reduction, funding changes, etc.)
Operating Budget
Plantory Connection
Please tell us why your organization is a good fit for co-working at the Plantory
How do you hope to connect with the organizations in the Plantory?
What types of relationships are you looking to build, what kinds of resources do you have to share with your neighbors, what resources are you hoping to find in the Plantory community, etc.
The location of the Plantory is
Not Important
Very Important
Clear selection
24-hour access is
Not Important
Very Important
Clear selection
Access to meeting space is
Not Important
Very Important
Clear selection
The reputation of the Plantory is
Not Important
Very Important
Clear selection
Working with like-minded organizations is
Not Important
Very Important
Clear selection
Sharing resources with like-minded organizations is
Not Important
Very Important
Clear selection
Having a healthy work environment is
Not Important
Very Important
Clear selection
If you would like to offer any additional information concerning your organization, projects, funding, staff, etc., please do so here
Plantory Development
Are there other organizations that you would like to see join The Plantory? Please give us their contact information. Thank you!
Do you have any ‘wish list’ items? (i.e. Amenities that you would like The Plantory to offer?)
Are there specific training topics that you would like our programming to incorporate?
Are you interested in having support from the Plantory interns? If so, what type of projects do you hope to get their help with?
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