Name of Person filling out the form
*
Job Title
*
How many years have you been in your current role?
How would you best describe your role within your organization?
*
Executive leader - I set strategic direction and sign off on partnership & programmatic decisions.
Director level - I direct the day-to-day operations within my department.
Management level - I oversee program team members who implement the work.
Direct Services - I work directly with clients.
Email address
*
Phone Number
Please enter a valid phone number.
Organization Name
*
How long has the organization been in operation?
*
Address
*
Street Address Line 2
City
*
State / Province
*
Postal / Zip Code
*
Organization website
*
Organization mission statement
*
How did you hear about ĒMA?
*
Online- came across website, social media, etc
Knew someone helped by ĒMA
Networking/Partner group- Praxis, CAFO, Stand Together, etc.
Another Affiliate organization
Mutual contact introduced us
other
Other
Organization vision statement
Organization Core Values
Briefly describe your core programs of service.
*
Briefly describe the majority of clients you serve.
*
How do clients hear about your program and/or who are your main referral partners?
*
Briefly describe your current volunteer opportunities.
*
What interests you about the ĒMA program and our model of redemptive mother advocacy?
*
What need or gap could you envision the ĒMA program solving for your organization?
*
How does your organization understand the foster care crisis, and what part do you believe prevention plays in addressing it?
*
What role, if any, do you see the church playing in supporting families and preventing foster care involvement?
*
Is your organization comfortable working with communities of faith on this issue?
*
I understand that the ĒMA program requires an investment from the Affiliate organization of internal staffing resources to champion and supervise the program, along with a full-time ĒMA Coordinator staff position to implement the program.
*
Yes, I understand.
Yes, but I have more questions.
We cannot commit to those requirements at this time but would still like to learn more.
Submit
Should be Empty: