Application for Consulting Support
Please note that the Model Built on Faith consultant support is provided free of charge for selected program participants based on our assessment of potential program impact. Slots are limited. Selected organizations are required to be active partners in building their own capacity by responding in a timely manner to consultant communications, attending all scheduled meetings, providing necessary documentation, etc. Thank you! We look forward to working with you.

This free 1-on-1 Technical Assistance is open to Nonprofit and Faith-based leaders and members.
Sign in to Google to save your progress. Learn more
1.) Name *
2.)Title *
3.)Name of key organization contact who will work with the consultant? *
4.) Name of organization *
5.) Name of program (if different)
6.) Address
7.) Phone Number *
8.) Fax
9.) Email *
10.) Web Address
11.) Is your organization faith-based? *
12.) How would you describe the populations you serve? *
13.) What geographic areas do you serve? *
14.) Are there individuals from your organization who can commit to participating in ongoing workshop sessions? *
15.) Does your organization have a 501-C-3 designation? *
16.) Does your program have a separate 501-C-3 nonprofit designation? *
17.Does your organization or program have a fiscal sponsor? *
18.) When was your organization/program established? *
19.) Have you conducted a needs assessment to determine whether there is a documented need for this program in your community? *
20.) Is your leadership, including the board of directors aware of and committed to supporting this program's development? *
20.) Is your leadership, including the board of directors aware of and committed to supporting this program's development? *
21.Please identify the specific organizational issue your organization seeks to address with this consultant support. Please check the box that describes your priority. *
22.) If you answered "other" to the previous question please specify
23.) Please tell us more about what your organization/program does and how it impacts the community. How does your organization promote equity? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of OCCUR. Report Abuse
Google Forms