FORM 1023-EZ for SCHOOL PSYCHOLOGY SUPPORT NETWORK

Field Data
EIN 85-2717003
Case Number EO-2021076-000676
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SCHOOL PSYCHOLOGY SUPPORT NETWORK
Organization’s Mailing Address 2010 EL CAMINO REAL PMB 3065
City SANTA CLARA
State CA
ZIP 95050
Accounting period End 12
Primary contact name SARAH AUGUSTINE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EMILY BERSAGLIA
PRESIDENT
2893 UNION AVE
SAN JOSE CA 95124

Officer/Director/Trustee Two

SARAH AUGUSTINE
TREASURER
5401 WINSLAND LN
CHARLOTTE CA 28277-0527

Officer/Director/Trustee Three

AMBER BOYKIN
PRESIDENT ELECT
164 LOUP GAROU LANE
CALHOUN LA 71225

Officer/Director/Trustee Four

LESLIE BAUNACH
EXECUTIVE DIRECTOR
92-971 MAKAKILO DR NUMBER 13
KAPOLEI HI 96707

Officer/Director/Trustee Five

AMY IVEY
SECRETARY
745 HERMAN SCOTT RD
STANTONSBURG NC 27833

Organization’s website
Organization’s email SchoolPsychologySN@gmail.com
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/6/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B03 - Professional Societies, Associations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SARAH AUGUSTINE
Signature Title TREASURER
Signature Date 1/18/2021

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