Partner Agency Application
The Central New York Diaper Bank is a 501(c)(3) nonprofit charitable organization that exists to help partner agencies working with families in crisis meet their need for diapers.  Diapers are provided at no charge to approved partner agencies.  The quantity of diapers available for distribution is dependent upon donations to the Diaper Bank.

Please tell us more about your organization, the social service(s) you provide and some general information about your average diaper needs (numbers of families you serve with diaper needs, sizes needed, frequency of distribution, etc.):
Email *
Organization Name *
Address 1 *
Address 2
City *
Zip Code *
Organization Website *
Director's Name *
Contact Name(if different)
Contact Phone *
Contact Email *
Type of Organization *
Required
Agency Mission *
Zip Codes Served (Separate By Comma) *
Services or Programs Provided *
How often do families receive services? *
Approximate Number of Families in need of diapers served on monthly basis *
Size of Diapers Typically Needed *
Required
Diaper Distribution Frequency *
Are you able to pick-up diapers from our storage location in Liverpool? *
Days available for Pick-up *
Required
What we ask of our partners:
1.  All diapers provided by the CNY Diaper Bank be distributed directly to your clients without charge. Diapers are to be given in quantities of 50 and pull-ups in quantity of 30.
2.  Acknowledgement that the CNY Diaper Bank may reject or cancel partnership at any time due to lack of resources or any other reason.
3.  Basic demographic forms and outcome surveys are completed on your part so that the CNY Diaper Bank may gather information about how many individuals and/or families were served by the diapers we provided.  Failure to provide information may result in removal from the Diaper Distribution Network.

Please read and acknowledge:
Diaper Bank items may not be sold, bartered or exchanged. Items received from the Diaper Bank may not be taken by volunteers, officers, clergy or employees for personal use. As outlined in the Internal Revenue Code Section 170(e)(3), all items you receive from the Diaper Bank must be used solely for the care of the ill, needy or minors, pursuant to your organization's charitable purpose.
I have read and agree to the above statements. *
Authorized signature: *
May we use your logo and link to your website on our site?
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How did you hear about us?
PLEASE NOTE:
New partners will be activated as resources allow.
Potential partners are encouraged to submit an application, which will be date-stamped and kept on file.
As resources allow, partners will be activated, notified and will receive the diaper request form.
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This form was created inside of Central New York Diaper Bank Inc..