The Media Foundation - Non-profit Partner Application
To partner with us, take a moment to complete this one-page application. You’ll subsequently hear from one of our associates regarding potential timing and next steps. If approved, The Media Foundation will provide a start date for your campaign with clear, customizable resources to incorporate in your communications.
Email address *
Organization Name: *
Year Established: *
Mailing Address: *
City: *
State: *
Zip: *
Physical Address (if different from above):
EIN/Tax ID: *
Social Media Links:
Mission Statment: *
Contact Personnel
Preferably Executive Director/Development Director and Facilitator. A minimum of one contact person is required.
Name: *
Position: *
E-mail: *
Phone: *
Describe planned use of funds: *
Please provide measurable goals that can be compared after the campaign so we can further promote the great work you are doing with our constituents.
Describe impact of your organization: *
Describe how your organization measures impact/how your impact has changed over time: *
Check your organizational focus/type
Terms and Conditions
Developing a mutual relationship based upon trust is critical to the long- term viability of this program. Abuse or misreporting of product may result in immediate suspension from the program. This program is not available to individuals or organizations other than those who maintain 501(c) status; organizations failing to maintain this tax status will be disqualified from the program. The Media Foundation may choose to discontinue this program at any time.
I have read and accept the terms and conditions *
Please sign and date the form below. Your electronic signature counts toward legally binding agreement to the terms and conditions as stated above.
Electronic Signature (Name, Title) *
Organization Name *
Date *
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