Community Affiliates Network (CAN) Application Thank you for your interest in joining our Community Affiliate Network (CAN). Joining CAN will give you access to grant opportunities, monthly calls with like-minded community leaders, online classes, and much more. For the application, please answer the following questions honestly and thoroughly as you can. For more information or questions, please feel free to contact CAN@woodsoncenter.org AFFILIATE APPLICATION & TECHNICAL ASSISTANCE FORM * Required Which option best describes you or your organization? * Individual Applicant501(c)3: Charitable organizations, NonprofitPending 501c3Limited Liability Company (LLC)Other [group group-organization] Organization Contact Organization Name: * Name of CEO/President/Executive Director: * Street Address: * City: * State: * —Please choose an option—ALAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip code: * Work Phone: * Home/Cell Phone: * Email: * [/group] [group group-individuals] Please email CAN@woodsoncenter.org for more information [/group]Next[group group-organization] Organization Information Share the mission/vision of your organization: * What activities does your organization do for the community?: * Share the connection your organization has to the community served: * By "connection", we mean how and why your organization decided to serve this specific community, how long your organization has served this community , if majority of staff/volunteers live within the community served, and other details that highlight the trust between your organization and the community. How many paid staff does your organization have? * None (0)Small (1-9)Medium (10-19)Large (20+) How many volunteers does your organization have? * None (0)Small (1-9)Medium (10-19)Large (20+) What category of assistance does your organization fulfill? * Check all that apply Violence PreventionRe-entryEconomic MobilityEducationArts and CultureHealth and WellnessMentorship Who helps your organization achieve your mission? * Check all that apply Local steering committeeMentorsOther concerned residentsVolunteersFaith CommunitiesOther Which of the following does your organization currently have in place? * Check all that apply Board of DirectorsArticles of IncorporationSecretary of State RegistrationStrategic PlanAnnual Report and/or Summary Report [/group] BackNext[group group-organization] Organization Funding Please write down the most recent annual budget of your organization. * the amount of money your organization spent in the most recent fiscal year (Example. 2020-2021: $10,000) Please share your organization’s budget distribution (Must add up to 100%): * Upload most recent 990 form if available: File Format: PDF, TXT. Maximum File Size: 10mb [/group] BackNext[group group-organization] Community Impact Provide an estimate of the racial demographic of the community served. (Total must add up to 100%): * Provide the age range your organization serves: * Youth (0-17)Young adults (18-25)Adults only (18+)All Ages (organizations that serve families should select this option) Which gender does your organization primarily work with? * All maleAll femaleBoth How many members of the community does your organization serve? * 1-50 people51-100 people101-200 people201-500 peopleover 500 people [/group] BackNext[group group-organization] Social Media If available, please share the following social media accounts: * [/group] BackNext[group group-organization] Organization Needs Board of Directors (governance): * Please select the areas that your organization needs assistance or improvement. Selecting/developing a boardBoard roles/responsibilitiesWorking with boardsOther Financial Management: * Nonprofit bookkeeping/accountingBoard treasuryFinancial statementsAnnual 990 filingOther Human Resources: * Personnel policies/manualJob descriptionsPerformance appraisalsPosting jobsTrainingOther Marketing/Communications: * Website development/designComputer trainingNewsletter writingSocial MediaOther Organizational Development: * How to become a 501c3Developing mission statementsPersonnel managementUsing volunteers to support staffOther Program Development: * Record keeping systemPerformance measuresEvaluating programsOutreach/promotion, enrollmentUsing work plans and logic modelsOther Resource Development: * Grant writingFundraisingIn-kind donationsPresenting to donorsCultivating donor/external relationshipsOther How did you find about the Woodson Center?: * Internet SearchSocial MediaNewsFamily/FriendBlog/Online articleOther If you learned about the Woodson Center through a CAN affiliate or person, please write the name in the text box: [/group] BackNext[group group-organization] Next Steps Upload a headshot of the CEO of this organization *File Format: JPG, PNG. Maximum File Size: 5mb Provide a short bio of the CEO below: * Provide a short bio of the organization below: * [/group] Back
