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
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