New Member Application 2024

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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 a signed No Fossil Fuel Affidavit . If you do not wish to sign the affidavit please send us your most recent 990 Schedule B Form. Please make sure the Schedule B section is uncensored. We ask for the signed No Fossil Fuel Affidavit or the 990 Schedule B form in order to ensure our membership does not receive fossil fuel funding. If you have further questions about this please reach out to membership@usclimatenetwork.org.

Important links to read through before applying to USCAN:

1.) No Fossil Fuel Affidavit Found Here: https://drive.google.com/file/d/1gdHktnOgs3r2hrJ23lfM53vMuZksXEgY/view?usp=drive_link

2). Jemez Principles for Democratic Organizing: https://www.usclimatenetwork.org/principles-of-working-together

3.) USCAN's Justice Equity Diversity & Inclusion (JEDI) statement, checklist & definitions: https://www.usclimatenetwork.org/justice_equity_diversity_and_inclusion

Email *

Full name *

Date *

YYYY

Primary contact's title *

Primary contact's phone number

Organization's Name
*

Organization website and social media
*

Organization's Address *

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: *

What is your organization's billing contact name, title, email and phone number? *

What is the annual budget of your organization and approximate budget for climate related work? *

Please list your top five funding sources for the last twelve months *

In the space below, share why you want to join USCAN. *

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? *

What are the main partners and coalitions with which you currently work? *

How did you hear about us, if not referred by a USCAN member? *

Have you read the Jemez principles and are you agreeable to utilizing through your work with USCAN? *

Yes

Other:

Send me a copy of my responses.

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