Google Grants Application (BETA) Please use this printer friendly version to gather information and draft your answers. Your actual application must be submitted using the online form at http://services.google.com/googlegrants/application. Only forms submitted online will be considered for Google Grants. Note: Your organization must have 501(c)(3) status for consideration at this time.

Organization Information Name of organization: ___________________________________________________________________ Legal name: ___________________________________________________________________________ Mailing address: Street _________________________________________________________________________________ Street 2 _______________________________________________________________________________ City __________________________________________________________________________________ State (please circle one) Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming Zip Code _____________ Phone number (example: 555-555-0000): ____________________________________________________ URL of website: ________________________________________________________________________ Year founded: __________________________________________________________________________

Contact Information Head of organization: ___________________________________________________________________ Title: _________________________________________________________________________________ Organization contact person: _____________________________________________________________ Job title / function: ______________________________________________________________________

Phone number (example: 555-555-0000): ____________________________________________________ Fax number: ___________________________________________________________________________ Email address: _________________________________________________________________________

Additional Information Does your organization have 501(c)(3) status? Yes / No Employer ID# : _________________________________________________________________________ Organization type (please circle one): Arts, culture & humanities Education Environment & animals Environmental quality, protection & beautification Health Mental health, crisis intervention Diseases, disorders & medical disciplines Medical research Human Services Crime, legal Employment Food, agriculture & nutrition Housing, shelter Public safety, disaster preparedness & relief Recreation, sports Youth development International & foreign affairs Public, societal benefit Advocacy Community improvement, capacity building Philanthropy, volunteerism & grantmaking Science & technology research Social science research Mutual / membership benefit Other If other, please describe: ____________________________________________________ Organization Mission Statement / Primary Objective: (Briefly describe the nature of your organization, your activities, your clientele and the location(s) of the services you provide -- character limit 1000.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Does your organization operate solely in the San Francisco Bay Area? Yes / No If yes, please describe: _____________________________________________________ Does your organization have operations outside the U.S.? Yes / No If yes, please circle one option: Africa Asia Caribbean Central America Europe Middle East South America Oceania / Pacific Islands All of the Above Other If other, please describe: ____________________________________________________ If your organization is U.S. based only, please circle the option that best reflects the region(s) you serve: Nationwide Multi-State / Regional Statewide Local Please circle an option that best describes the community you serve: Rural Urban Reservation Other If other, please describe: ____________________________________________________

What areas are the primary areas of focus of the day-to-day efforts of your organization? (Please circle up to three options from the following list.) Children, youth & families Civic participation & electoral reform Community affairs Economic development Environmental conservation HIV / AIDS Human rights International relief & development LGBT community Media & freedom of expression Native American issues Peace / international conflict Animal welfare & rights Social services Women's issues Other If other, please describe: ____________________________________________________ What strategies does your organization use to effect change through your efforts? (Please circle up to three options from the following list.) Advocacy Organizing Coalition work Cultural work Direct services Electoral reform Grassroots organizing Legal services Media services Public policy reform Spiritual / healing Training & technical assistance Other If other, please describe: ____________________________________________________ Number of full-time staff: ________________________________________________________________ Number of part-time staff: ________________________________________________________________ Number of volunteers: ___________________________________________________________________ Annual operating budget (please circle one): $0 - $249,999 $250,000 - $499,999 $500,000 - $749,999 $750,000 - $999,999 $1,000,000 and over Size of endowment: $____________________________________________________________________

Are you affiliated with political advocacy groups? Yes / No If yes, which ones? ________________________________________________________ Are you currently advertising online? Yes / No If yes, where? Annual advertising budget: $_____________________________________________________________ Explain how you expect Google AdWords advertising will contribute to your organization. (Please limit your response to 500 characters.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Who is your target audience for online advertising? (Please limit your response to 150 characters.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Please provide a sample of an ad you might run through Google Grants: Line 1: (25 character headline) ________________________________________________ Line 2: (35 character limit) ____________________________________________________ Line 3: (35 character limit) ____________________________________________________ Line 4: (display URL-- 35 character limit) ________________________________________ Please provide a list of keyword / keyword combinations that you feel are relevant to your organization: _________________________________________________________________________ What are your website traffic figures (hits per month)? _______________________________________

Do you accept online donations? Yes / No Please list any website awards/honors: ____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ How did you hear about the Google Grants program? (Please circle one option) Google Employee Other If other, please describe: ____________________________________________________

Remember, your actual application must be submitted using the online form at http://services.google.com/googlegrants/application. Only forms submitted online will be considered for Google Grants. ©2002 Google