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Client Intake Form - 2023
All information requested is held under STRICT CONFIDENCE and collected only for the purposes of providing Jody Yaa Consulting with the information required to provide a quote or direct service delivery (with the exception of information required to be released to potential funders for grant writing services, sponsors, or collaborative partnerships). Disclosure verification must be provided by client prior to releasing information for the purposes noted above.
* Indicates required question
Legal Organization / Business Name:
*
Your answer
Does the organization / business go by a different name publicly? If so, please provide the name:
Your answer
Mailing address:
*
Your answer
Current Status:
*
Exploratory Phase - not registered, exploring ideas, community mapping, etc.
Developmental Phase -registered, beginning to build structure (volunteers, steering committee, no formal customers or clients)
Early Phase (currently in full operation for 0-2 yrs)
On-going Active Phase (currently in full operation for 3-10 yrs)
Long-term Active Phase (in full operation for 10+yrs)
Organization / business Registration Date: (if unsure, provide approximate date)
MM
/
DD
/
YYYY
Business Registration Type:
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NFP - not-for-profit
Sole proprietorship
Partnership
Corporation
Limited Liability Company (LLC)
Not-registered
Other:
Master Business Licence Number (if applicable)
Your answer
Charitable Number (if applicable)
Your answer
If you do not have charitable status, do you have a Trustee or Mentorship organization?
*
Currently in a formal trustee relationship for funding/support
Yes - we have a a trustee confirmed, but NOT currently utilizing their support formally
In the process of researching potential trustees
No trustee / No potential leads
N/A - we have charitable status
N/A - we are a for-profit business
Elevator Pitch: How would you describe in TWO or THREE short descriptive sentences, what the organization or business is all about? (consider the who, what, where, when and why, along with what makes your service unique)
*
Your answer
Is there a Mandate, Vision, key deliverables/outcomes or Impact Statement? If so, please provide below:
Your answer
Online Presence - please provide your website address and social media handles (Instagram, FB, Twitter, Linkedin, etc):
*
Your answer
Do you PRIMARILY provide services to any of the following communities?
*
African, Caribbean Black (ACB)
Indigenous
BIPOC
N\A
Required
Is your organization / business Black owned, Black-led or Black-serving? (over 50% representation in front-line/middle & senior management as well as at the board level)
*
Black-owned
Black-led
Black-serving
N/A
Required
Where is your organization / business providing services (currently or aspiring):
*
Locally
Provincially
Nationally
Internationally
Are services provided: (currently or aspiring)
*
Only in-person
Only Virtually
Hybrid (mixture of in-person and virtually)
n/a
What are potential areas of support Jody Yaa Consulting could assist you with?
*
Brainstorming or Consulting sessions (one on one, board or team focused)
Logic Models, business plans / strategic planning
Governance - board Development
Registering a business / NFP org
Policies & procedures
Proposals, slide decks, one pagers
Program design
Document review & revamp
Organizational review
Grant writing
Partnerships / collaborations
Loans, grants, sponsorships & funding
trainings, workshops, presentations
graphic designs (info-graphics, layout design)
Online audit (website, social media, etc)
Branding, logo design & marketing
Action item check-lists
Addressing challenges
Staffing - hiring, employment postings, job descriptions, orientations
Employability - cover letters, resumes, portfolios, interview prep
Volunteerism - engagement strategies, training, management of volunteers
Printing - business cards, flyers, one pagers, proposals, reports, banners, etc.
Other:
Required
Do you have any immediate concerns, challenges or time sensitive action items you are hoping to receive specific support with? If so, please provide brief, clear details outlining each item:
Your answer
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