Diaper Depot Partner Agency Application
1.During the application process a site visit and/or agency interview may be requested.
2. The Diaper Depot reserves the right to decline applications based on a variety of criteria and community need.
3. Please attach proof of your organization's status: a. IRS Determination Letter showing 501(c)3 standing with the IRS, b. Letter of Good Standing from National/Regional Headquarters (if applicable), or Government Letterhead (if applicable)
4. Sign and date application. By entering your name in the area provided you are certifying that you have authority to act on behalf and speak for the Agency.
5. Information provided will be made available to Junior League of Topeka Diaper Depot, 1251 SW Arrowhead, Ste. 120, Topeka, KS 66604.
6. Questions and further information may be directed to JLT CIC Project Chair at email@jltopeka.org.
7. Your application will be reviewed within 30 days of its completion and submission.
Agency Name TRM Ministries (Topeka Rescue Mission Inc) *
Your answer
Agency Mailing Address 600 N Kansas *
City, State, Zip Topeka, KS 66608
Your answer
Agency Website www.Trmonline.org *
Your answer
Contact Information Kay Ireland Director of Distribution Services (785) 357-4285 Kireland@trmonline.org
Executive Director Barry Feaker *
Name, Phone, Email 354-1744 x 315 Bfeaker@trmonline.org
Your answer
Program Contact Person Debra Sabb Director of Women and Family Services, (785)354-1744 x 337, Dsabb@trmonline.org Jessica Hossman Children's Palace Director, (785) 354-1744 x 325 Jhossman@trmonline.org *
Your answer
Program Using Diapers Within Your Agency
On-site emergency housing, Pre-School Daycare
Name of Program Using Diapers Hope Center Women and Family Shelter and Children's Palace *
Your answer
Agency mission/service provided to the community Shelter Services: Providing shelter to those who are experiencing homelessness Children's Palace: Providing a safe, nurturing, educational and Christ-centered children's program. *
Your answer
Description of how your agency will be using diapers We will be providing diapers for the children's use while at the Hope Center and for the children while at the Children's Palace. *
Your answer
How will the diapers be used by your program? *
Do you measure outcomes for your program? No *
explai
Your answer
Will diapers be distributed without conditions? *
Will recipients be required to attend classes, purchase diapers, make promises, etc.? Explain. There are no requirements for the Hope Center other than Homeless. There are no requirements for the children at the Children's Palace but the parent will be required to participate in classes with and for their children.
Your answer
Do you receive diapers from another steady source? *
Do you currently turn away clients due to a lack of diapers? *
Agency's Demographic Information
Describe the population you serve Homeless *
Your answer
Geographic location of your clients by zip code
if known
Your answer
Average number of children less than 2 years old you serve per month *
Your answer
Percentage of diaper recipients living below the Federal Poverty Level 100% *
Your answer
Of the total population that you serve, what percentage of the population includes the following race: *
Number should total 100%
Required
Your Agency's Capabilities and Resources
Does your agency have the ability to store diapers? *
How much storage space could be committed to diapers? (Approx. sq. feet)
Your answer
How large of a staff does your agency have? *
Are these people employees, volunteers or a combination?
Your answer
How much time is your agency willing to commit to Diaper Depot? *
Diaper Depot programs could require from 3-30+ hours per month.
Your answer
Is your agency willing and able to track demographic information? *
Demographic information consists of race, gender, annual income, etc.
Required
Does your agency use the MAACLINK/Client Trak system? *
Required
Number of Clients Served by Age
Average number of Clients served each month. Diaper Depot realizes this number will vary month-to-month and your agency will not be held to exact numbers based on this form. Numbers of diapers that would be distributed will be based on diaper availability and completion of a diaper order form once accepted as a partner.
0-1 month old *
Your answer
2-4 months old *
Your answer
4-9 months old *
Your answer
9-12 months old *
Your answer
>12 months old *
Your answer
Is there any other information you would like the Diaper Depot to know regarding the need of your clients or the services you provide?
Your answer
Executive Director Signature *
By typing your name below, you are acknowledging that all information provided is accurate to the best of your ability.
Your answer
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