TAGNW Reconnect Partner Application Form
Please refer to the TAGNW Reconnect project and Partner information for program details:
https://tagnw.org/reconnect
https://tagnw.rog/reconnect-partners

We request that applications are completed by an organization staff member capable of creating a program partnership with TAGNW. Please note that there are no costs to participate in the program for either the organization or participants.

Applicant Requirements:
* Nonprofit or Government social services agency.
* Provide social services to the public.
* TAGNW Gratis Business Member.

Please contact Michael Gan, TAGNW Executive Director, at director@tagnw.org or 360-312-7105 for any questions or comments.

NOTE: All fields are required, but you may note "NA" if not applicable.
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ORGANIZATION INFORMATION
Organization Name *
Organization Phone Number *
Organization Website *
PRIMARY CONTACT INFORMATION
Contact Name *
Contact Phone Number *
Contact Email Address *
APPLICANT INFORMATION
Please describe your organization and the social services that you provide to the public. *
How will your participation in the TAGNW Reconnect program support your organization? *
How will your participation in the TAGNW Reconnect program support the public that you serve? *
CONFIRMATION
I confirm that I represent the applicant organization and that we are a nonprofit or government social service agency providing services to the public. I have reviewed the TAGNW Reconnect program and partner information. I wish for our organization to participate in the TAGNW Reconnect program as a program partner. *
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