Social Innovation Application Fee

Please fill out the information below for consideration. Please note there is a $100 non-refundable application fee required to submit your application.

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Your Information

* First Name

* Last Name

* Address

* City

State

* Postal Code

* Email Address

Phone Number

Select the Social Innovation Application Fee below

$100.00 - Social Innovation Application Fee

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American Express Discover MasterCard Visa
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Program Information

* Nonprofit Name
Please email proof of 501(c)(3) (either IRS Affirmation/Determination Letter or Tax Exempt Certificate) to info@uwsocialinnovationcenter.org.

* Street Address

* City

* State

* Zip Code

* Tax ID #

Website (if you have)

* Membership Type Requested
Co-working Space
Private Office
Unsure

* Brief description of your organization and services

* How many staff members are you considering for the space (including you)?

How did you hear about us?

Other (Anything else you would like us to know about your organization?) Please include any innovative ideas or approaches your organization is pursuing that will help people and communities.

* I understand that submission of this application does not guarantee acceptance. All decisions regarding the Social Innovation Center are made at the sole discretion of United Way Worldwide.

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