About Your Organization Form

Name of Organization*

Organization Website URL

Operating City*

Organization Address*

List the neighborhoods your organization serves (comma separated)*

Organization Mission Statement*

List of programs offered to your clients (comma separated)*

What is your organization's main goal or target focus?*

What is your annual budget?*

How many people does your organization employ?*

0-50

50-250

250-500

500+

How many social workers/case managers does your organization employ?*

0-50

50-250

250-500

500+

How many clients does your organization service annually?*

0-50

50-250

250-500

500+

Who is your primary clientele? (select all that apply)*

Veterans

Youth & Children

Domestic Violence

Foster Youth

Human Trafficking

Hospital Patients

Families dealing with severe illnesses

Elderly

Formerly Incarcerated

Justice & Gang Involved

Other

What percentage of your clients are employed earning a minimum gross household income of $25,000?*

0-25%

26-50%

51-75%

76-100%

Do you have a dedicated department that works with employed clients?*

Yes

No