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Potential Host Evaluation Form

This form will help FY Eye evaluate if your organization's location is well suited for our mission to disseminate public service announcements that generate awareness of not-for-profit organizations and their programs as well as important social, civic service and educational messages.

FY Eye provides funds to tax-exempt organizations for the purchase, installation and maintenance of digital screens. Each host location is entitled to 60% of the on-screen time for their own marketing purposes, while the remaining 40% is allocated for recommended public service announcements (PSAs).
Each host organization has the right to refuse any PSA for any reason.

Please fill out the following questionnaire to learn more about how to join the FY Eye Digital Signage Network.

Name *

First

Last

Email *

Phone Number *

-

Name of the Tax Exempt Organization *

Organization's Address *

Line 1

Line 2

City

State

Zip Code

Country

The address in which the screen(s) will be located. If you have more than one location, please indicate this in the following question.

Where does your organization hope to install screens? *

Please be as detailed as possible.

What type of equipment are you most interested in? *

Indoor Screens Outdoor Screens Storefront Screens (Indoor screens visible from outside)

Please check all that apply.

Does your organization currently have digital screens? *

Yes No Not sure

Approximately how many people visit your location each month? *

What is the estimated percentage of visitors who fall at or below the poverty line? *

Who of the following will benefit from the screen(s)? *

Children Teens Adults Elderly Families

Please check all that apply.

Please provide the ethnic breakdown of the community that will be exposed to the screen(s) *

Please be as detailed as possible.

What services do your organization provide? *

Please list specific services and programs.

Are there any bordering communities that access your services? *

Please list all communities and their significance to your organization.

Please list any other important factors as we determine if your organization would be an ideal candidate to join the FY Eye digital signage network. *