JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
New Member Application 2021
Hello! Welcome to the first step of the USCAN Membership application process. To begin, we invite you to review a few documents (below), and complete this application form.
Once you submit this application please email
membership@usclimatenetwork.org
your organizations most recent annual report (if you have one) and your 990 tax form including the schedule B. We are reviewing finances to determine if applicants receive funding from fossil fuel companies. If sending over taxes is difficult there is an alternative for our financial review outlined in point "4.)" below.
Important links to read through before applying to USCAN:
1). Jemez Principles for Democratic Organizing (
https://www.usclimatenetwork.org/principles-of-working-together
)
2) USCAN's 5-year Strategic Plan (
https://www.usclimatenetwork.org/strategic_plan_2017_2022
)
3.) USCAN's Justice Equity Diversity & Inclusion (JEDI) statement, checklist & definitions (
https://www.usclimatenetwork.org/justice_equity_diversity_and_inclusion
)
4.) If you do not have a 990, please download, sign and submit the No Fossil Fuel Affidavit to
Membership@usclimatenetwork.org
(
https://docs.google.com/document/d/1H56zo1wbRcyF7UDX6nj26gb76koOyj42xCDoFvi0h3k/edit?usp=sharing
)
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
Full name
*
Your answer
Date
*
MM
/
DD
/
YYYY
Primary contact's title & phone number
*
Your answer
Organization's Name, website & social media
*
Your answer
How is this organization incorporated?
*
501(c)(3)
501(c)(4)
501(c)(5)
Religious institution not with any official status
Tribal Government
Registered as state non profit or similar designations
Organization has a fiscal sponsor - If you have a fiscal sponsor we require a letter from them acknowledging they support your application.
Other:
Please include a short paragraph to be used to introduce your organization to the membership that includes your current work and recent accomplishments:
*
Your answer
What is your organization's billing contact name, title, email and phone number?
*
Your answer
What is the annual budget of your organization and approximate budget for climate related work?
*
Your answer
Please list your top five funding sources for the last twelve months
*
Your answer
In the space below, share why you want to join USCAN.
*
Your answer
Are there any USCAN members who you currently work with who can talk to about your work. List below. Were you referred by a USCAN member?
*
Your answer
What are the main partners and coalitions with which you currently work?
*
Your answer
How did you hear about us, if not referred by a USCAN member?
*
Your answer
Have you read the Jemez principles and are you agreeable to utilizing through your work with USCAN?
Yes
No
Other:
Clear selection
Have you read our 5yr Strategic Plan?
Yes
No
Clear selection
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of US Climate Action Network.
Report Abuse
Forms
