Organization Name *

Website URL *

Street Address *

City *

State *

Zip *

Country *

Contact's First Name *

Contact's Last Name *

Contact's Email *

Contact's Phone Number *

Contact's Job Title *

EIN *

What is your organization’s mission?: *

What progress is your organization making towards your mission?: *

Does your organization have any politcal/religious affiliations? If so, please explain.: *

Please describe your organization’s major programs and services.: *

How many total staff does your organization employ?: *

Please tell us how a Wisetail LMS would benefit your organization.: *

Please tell us who would administer the LMS for your organization.: *

What audiences would use the platform and how would each audience use it? *

Please tell us your plans to successfully introduce the system to each audience you listed above.: *

Do any Intertek employees serve as board members or hold key leadership positions within your orgnization? * YesNo

Have you ever contracted Wisetail or Intertek services? * YesNo

Are you a religious or government-related non-profit organization? * YesNo

Could the grant create any potential conflicts of interest with Intertek? * YesNo

Could the grant indirectly support political activities? * YesNo

Anything else you would like to share about your application?:

Yes, please keep me updated on all things Wisetail. * I agree to the terms below.

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