Member Organization Application
Organization Details
Program or Organization Name
Street Address
City
State
Zip Code
Facebook Profile
Website
LinkedIn Profile
Instagram Handle
Organization Email
General email for the organization, not your email
x
Organization Phone Number
Main phone number for the organization, not your phone number
x
Organization Classification
Do you have a federal 501c3 status?
Yes
No
Are you a United Way Agency?
Yes
No
Which category best describes your organization?
Please select...
Company
Corporate Foundation
Governmental Organization
High School
Media
Nonprofit
Post-Secondary Educational Institution
Religious Organization
Veteran Service Organization
Workforce Solutions
Other
Select all that describe who your organization works with
:
Adults with Special Needs
College Students
Enrollment in continuing educational program
Domestic Violence Survivors
High School Students
Unhoused/Homeless
Human Trafficking Survivors
Immigrants/Refugees
Public Assistance Recipients
Other
Do your clients have any special needs that DFSH should be aware of in order to provide them with our services?
Hearing Impaired
Intellectual Disability
Limited English
Physical Disability
Sight impaired
Other Special Need
Educational Programs and Resources
Degrees and Classes Provided by your Organization:
High School diploma
GED
ESL
Associate degree
Bachelors Degree
Masters or PHD
Professional Certification
Vocational/Trade Training
Other Classes Provided
Resources Provided by your Organization:
Addiction Counseling
Child care
Clothing
Educational Opportunities
Food Assistance
Housing/rental assistance
Job Placement
Job Search services
Legal Assistance
LGBTQ+ Support
Mental Health services
Professional Development
Utilities Assistance
Other Resources
Submission Contact
Title
Mr., Ms., etc
x
First Name
Last Name
Email
Phone Number
Mobile number preferred
Job Title
Contact Information