Background

Amuta Number:    (must be 9 digits)
Exact Name of Organization:
Short Form of Name (abbreviation or acronym,    if it exists):

Address

C/o:
Street:
City:
Zipcode (mikud):
Phone Number:	( ) -
	( ) -
Fax Number:	( ) -
E-mail Address:
Website Address:

Geographic Area of Operation:

All of Israel In a specific city     Which city? Internationally

Year organization was approved as an amuta: (received amuta number)
Last year that a financial report was sent to the Registrar of Amutot:

Does your amuta have a review committee (Vaadat Bikoret)?
	Yes No C.P.A. is the review person instead of a committee
Which type of bylaws (takanot does your organization have?
	Standard Special

Officers

List clearly the names of the Board members (hanhala):

One sentence description of the Purposes of your Organization
(In 30 words or less, state the goals and major activity)

Israel Activity Classification Codes
Select up to three codes that most closely describe the activities of your organization.

Detailed Description
(In 100 words or less, please expand on the above one sentence, and include the history, philosophy, goals and purpose of the organisation.)

Programs
(In 100 words or less, please describe your major operating programs, services and activities, including the size of the organization, who are helped by the organization, your growth and the results.)

Major Accomplishments
(List up to three major accomplishments of your organization. Limit your response to 15 words per accomplishment.)

1.
2.
3.

Major Objectives
(List up to three major objectives/goals for your organization. Limit your response to 15 words per objective.)

1.
2.
3.

Effectiveness
How does your organization evaluate the effectiveness of its programs?
(in 50 words or less)

What are the most outstanding Present Needs or Projects Requiring Funding?
(In 30 words or less rank them by priority and indicate the dollar cost for each project)

First Priority
Cost
Second Priority
Cost
Third Priority
Cost

Funding

For which of the following items does your organization use contributions and grants?
Operating Expenses
Specific Projects
Buildings
Endowments
Other - Please specify    

Total Income for last tax year (in US$ at today's exchange rate):

Sources of Income for the last tax year (please make sure these values add up to 100%)

Total Expenses for last tax year (in US$ at today's exchange rate):

Breakdown of Expenses for the last tax year (please make sure these values add up to 100%)

Last year's deficit (in US$ at today's exchange rate)

Is your organization affiliated with a political party in Israel?
No
Yes - Please specify    

Are donations to your organization tax-deductible in Israel?
No
Yes - Please specify your Mossad Tziburi Number    

Are donations to your organization tax-deductible in the U.S.A.?
No
Yes - Please specify your I.R.S. (tax) Number    

Does your organization have a V.A.T. deduction (Malkar) status?
No
Yes

Will you make your audited tax (C.P.A.) report available on request?
No
Yes
We do not have an audited tax report

How many employees and volunteers do you have in your organization?

	Full time employees:
	Part time employees:
	Volunteers:
	Board (hanhala) members:

How are decisions made in your organization?
Mostly by the Executive Director
By the board (hanhala)
Other - Please specify  

What are your criteria for membership (who can join)?

Number of Members in the Amuta:		Israel:	Abroad:
Number of Branches:		Israel:	Abroad:

List two organizations abroad who know your work and can give you a reference:

	Reference Name	City
1
2

What type of publicity material does your organization publish?
Brochure
Annual Report
Video
None
Other - Please specify  

Additional Comments
(In 75 words or less, discuss any aspects of your organization that you would like to be published with your profile. This may include awards, achievements, success stories or new developments)

A short profile of your President or Chairperson
(In 75 words or less, please describe the background of the leader of your organization. This may include such aspects as significant work, honors, vision or life achievements)

Name:
Profile: