JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Ho'oikaika Partnership Application
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
In the partnership, I will represent:
*
Myself as an individual
My organization (I have permission/authority from my agency)
Unsure, let's discuss
What is your
FIRST
name?
*
Your answer
What is your
LAST
name? (You may also choose to list your credentials, e.g., MSW, PhD, etc.)
*
Your answer
Which sector(s) best describes your agency/organization or individual profession/perspective? (Select up to 3)
*
Advocacy organization
Business (including consultants)
Child Welfare Services (local or state)
County Government Department
Cultural Group
Domestic Violence Prevention/Intervention
Early Childhood Education (child care, Head Start, Pre-K)
Faith-Based
Family Strengthening Program
Education (K-12, public or private)
Elected official
Health Care Provider (medical)
Health Department (local or state)
Judiciary
Law Enforcement
Mental Health Services
Multi-Service Non-Profit
Parent
Philanthropy
Resource Caregiver/Foster Parent
Other Government Department (local or state)
Substance Abuse (Prevention/Treatment)
Youth Services
University/College
Other
Required
If you entered "Other" above, please describe your sector:
Your answer
What is your job/position title? (if not applicable, enter NA)
*
Your answer
Do you work with an organization that serves children and families? If yes, please choose from the list below.
*
Choose
'A'ali'i Alliance
Ai Pono Maui
Big Brothers, Big Sisters
Boys & Girls Clubs of Maui, Inc.
Casey Family Programs
Catholic Charities Hawaii
Child & Family Service
Child Welfare Services
Children's Justice Center of Maui, Hawaii State Judiciary
Community Children's Council of Hawaii
Consuelo Foundation
Department of the Attorney General
Department of Education
Department of Health, Adult Mental Health Division
Department of Health, Children and Adolescent Mental Health Division
Department of Health, Family Health Services
Department of Health, Public Health Nursing
Department of the Prosecuting Attorney, Maui
Goodwill Industries of Hawaii
EPIC 'Ohana
Family Hui Hawaii
Family Programs Hawaii
Friends of the Children's Justice Center of Maui, Inc
Hale Kipa
Hana Community Health Clinic
Hawaii Children's Action Network
Hawaii State Library
Hoʻomōhala O Moloka’i
Hui No Ke Ola Pono
Imua Family Services
Judiciary, State of Hawaii
Ka Hale A Ke Ola Homeless Resource Centers, Inc
Kaiser Permanente
Kamehameha Schools
Karen Worthington Consulting
Keiki O Ka Aina
Lāna'i Community Health Clinic
Leadership in Disabilities & Achievement of Hawai'i
Legal Aid Society of Hawaii
Lili'uokalani Trust
Maui AIDS Foundation
Maui Behavioral Health Resources - Aloha House
Maui Behavioral Health Resources - Malama Family Recovery Center
Maui Behavioral Health Resources - Maui Youth & Family Services
Maui County Council
Maui County Early Childhood Resource Center
Maui Economic Opportunity, Inc
Maui Family Support Services, Inc.
Maui Hui Malama
Maui Police Department
Maui Prosecutor's Victim/Witness Division
Maui United Way
Mental Health America of Hawaii
Mindful Living Group
MNI Counseling, LLC
Molokai Child Abuse Prevention Pathways
Molokai Community Action Team
Molokai Pilina Hui
Nā Keiki O Emalia
Office of Wellness and Resilience
Parent Leadership Training Institute
Parents and Children Together
Partners in Development Foundation
Royal Family Kids Maui
Sustainable Molokai
Teran James Young Foundation
Village of Hope Maui
Unite Us Hawaii
University of Hawaii at Manoa, Cooperative Extension
University of Hawaii, Maui College
Women Helping Women
Other
I do not work for an agency
If you answered "other" to the previous question, please write in the
FULL
name of your organization below (no abbreviations).
Your answer
Why are you interested in becoming a partner?
*
Your answer
There are many types of contributions you and/or your organization could make to the Ho'oikaika Partnership. In what ways are you interested in contributing? Please select all that apply.
Program Planning & Workforce Development
Help collect and analyze data
Contribute data to understand needs, gaps, and barriers in the system of care
Help plan annual conference
Provide professional development/training
Update strategic plan
Collaborate on grant proposals
Other:
Community Engagement/Outreach
Plan and/or attend community outreach events
Provide materials/supplies to distribute at outreach events
Recruit new partners and help onboard them
Conduct focus groups or talk story sessions with parents and caregivers
Other:
Public Awareness/Education
Share information about Protective Factors and HP with clients/colleagues
Share Ho'oikaika Partnership posts via social media
Develop content for newsletter, website, op eds and/or social media
Be a spokesperson for news articles, radio shows, or other media appearances
Provide training to partners/community
Share my organization’s events and trainings
Other:
Advocacy
Attend Maui County Council or Commission meetings and report back
Attend informational meetings with elected officials
Prepare written or verbal testimony on legislative issues
Make connections to policy makers, funders, and community leaders
Work on statewide advocacy issues/participate in legislative activities
Write letters to elected officials
Other:
What special skills or strengths would you like to share with the Ho'oikaika Partnership?
(e.g., writing, fundraising, presentations, cultural knowledge, community connections, taking pictures at events, graphic design, etc.)
Your answer
One requirement of being a partner is to serve on a committee. The committee I am most interested in joining is:
*
Creating a Seamless Safety Net
Training & Professional Development/Conference Planning
Public Education & Advocacy
Community Engagement/Walaʻau A Me Kukākukā (conversation & discussion)
Not sure
I'm unable to join a committee and will participate as an ally rather than a partner.
My organization is interested in joining the Leadership Hui. (See the HP charter for LH roles and responsibilities)
*
Yes
No
Maybe - let's discuss
My organization is already a Leadership Hui partner
Next
Page 1 of 2
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
