Black Impact Houston Membership Application

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Thank you for your interest in joining Black Impact Houston. Black Impact Houston (BIH) is an alliance of nonprofit organizations that are led by Black people and/or that have a mission that primarily benefits Black people and communities. Our primary focus is to support and strengthen Houston’s Black nonprofit community through belonging, education, advocacy, mentorship, and leadership.

Please read more about BIH membership here: https://bit.ly/blackimpacthouston

First and Last name *

Mailing Address

Email Address *

Telephone Number

Are you applying for organization or individual affiliate membership? *

Organization

Individual Affiliate

Required

Name of Organization or Affiliate *

Role in Organization *

Executive Director/CEO

Other (Please list below)

Other:

Required

What community(ies) do you primarily serve?

What focus area does your Black Led Organization (BL0) serve? *

Community Building

Leadership Development

Youth Development

Economic Development

Education

Social- Emotional Development

Stopping the School to Prison Pipeline

Health Services

Housing

Political Power Building/ Civic Engagement

Arts & Culture Promotion/ Education

Community Re-Entry

Other:

Required

Reported annual budget size for your Black Led Organization?

Less than $250,000

$250,000- $500,000

$500,000 - $750,000

$750,000- $1,000,000

$1,000,000 +

Clear selection

What are the strengths of your organization? *

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