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Family Organization Members Only
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Welcome to Membership
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Application for Donors
Application for Donors
Application for Donors
Name of Family-Run Organization
Address
Website
Type of Organization
Statewide
Local/Regional
Is the organization's board comprised of at least 51% parents or caregivers of children with emotional, behavioral or mental health needs?
Yes
No
Is the organization designated as a 501C3 organization?
Yes
No
Organization's Mission Statement
Name of Executive Director/CEO
Current Role/Title
Please Check Appropriate Category Regarding Your Current Role
Full time Executive Leadership
Part time Executive Leadership
If You Are The Current Executive Director, Years in Position
If Part Time, Describe Other Employment
Are You Now or Have You Been a Caregiver of a Child with Mental Health Needs?
Yes
No
Work Email
Work Phone
Cell Phone
Please upload the following items with your application: 1. IRS Letter of Determination as a 501c3 non profit 2. Current list of Board of Directors (including their role/representation) 3. Agency brochure
Drop files here or
Select files
Max. file size: 50 MB.
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