Partner Agency Application

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Babies of Homelessness is a 501(3)c nonprofit and diaper bank. We provide diapers, wipes and formula, on a monthly basis, to organizations that serve families who are experiencing homelessness or hardship.

To learn more about our organization and the work we do, please check out our website at www.babiesofhomelessness.org.

We look forward to learning more about your organization!

Organization Name: *

Mailing Address: *

Website Address: *

Director's Name: *

Main Contact Name (if different): *

Main Contact's Phone #: *

Main Contact's Email Address: *

Brief description of your organization, including what cities/counties you serve: *

Your organization is a (check one): *

501(c)(3)

Religious Organization

Government Organization

Approximately how many children in need of diaper support do you serve each month? *

Does your organization receive ongoing diaper support from any other diaper bank/agency? *

Yes

If yes, what organization provides you diaper support and how often? *

Do you have someone on staff who can submit monthly orders by a deadline? *

Yes

Can you provide Babies of Homelessness (BOH) with demographic information? *

Yes

Can your provide Babies of Homelessness (BOH) with written testimonials or outcome information when requested (1-2 times a year)? *

Yes

Partner Agencies pay a yearly partnership fee to BoH. Please indicate below which tier fits your organizations need.

Which tier fits your organization's needs? *

Tier 1 (1-35 children served monthly) - $200 yearly

Tier 2 (36-74 children served monthly) - $400 yearly

Tier 3 (75+ children served monthly) - $600 yearly

This fee is a barrier for our organization. We would like to receive a one year scholarship to cover the partnership fee. (Please still select a tier above to indicate your needs)

Required

Is there anything else you would like us to know? *

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