Yellow Pages Group

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Business Information

(ALL FIELDS ARE MANDATORY. ENTER N/A IF NOT APPLICABLE)

Business name: Address: City: Province: Postal Code: Phone: Ext: Email: (mandatory to receive confirmation Email) Web site: Business License and/or Tax number: Date of registration: Number of employees at time of application: Principal or Contact Name: Title: Contact Phone: Ext: Contact Email:

Beneficiary Organization

(ALL FIELDS ARE MANDATORY. ENTER N/A IF NOT APPLICABLE)

Name of Organization: Address: City: Province: Postal Code: Phone: Ext: Email: Web site: Contact Name: Title: Contact Phone: Ext: Contact Email:

Description of Business

Please provide an overview of your company.

(max. 300 words)

Questionnaire

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Please describe your company's initiative by answering the following questions. Please note, the answers must pertain to how your company has contributed to the community in the last 18 months. You may make your answers as detailed or brief as you like. Point form is acceptable.

1) Briefly describe the initiative your organization undertook.

(max. 300 words)

2) Is this initiative fullfilling a need within the community? Explain.

(max. 300 words)

3) To what extent did this initiative impact the community?

(max. 300 words)

4) Describe the amount of person hours, finances and/or other resources that have been committed to this initiative. (For example, are you a small business that leveraged all the resources of the company to make an initiative work, or a larger business that had spectacular results?)

(max. 300 words)

5) What is the potential for long-term sustainability of the initiative?

(max. 300 words)

6) Did the business set out with specific goals and if yes, what were they? Did it achieve these goals?

(max. 300 words)

References

Please provide at least two references (to a maximum of five) that are willing to be contacted. References should be able to speak to your initiative (i.e. charity organization, school, lawyer, supplier, banker, customer, etc).

1. Referee Name: Title: Referee Phone: Ext: 2. Referee Name: Title: Referee Phone: Ext: 3. Referee Name: Title: Referee Phone: Ext: 4. Referee Name: Title: Referee Phone: Ext: 5. Referee Name: Title: Referee Phone: Ext:

Application Form