If you are interested in learning more about becoming a CAS-Carrera replication partner, please complete the questionnaire below:
Organizational Information
Organization Name
Website
Street
City
State/Province
Zip Code
Is your organization a 501(c)3?
Yes
No
Name of Agency Contact
Title
Email Address
Phone
Organization's Mission
Type of Organization
Youth/Human Services
School/Academic Institution
Social Services
Health Department/Health Organization
Education/Advocacy
Other
Please describe
What year was your organization established?
What is your annual operating budget?
Please indicate if agency has experience with the following:
Implementing adolescent pregnancy prevention curricula, programs and/or services
Implementing evidence-based programs
Providing direct services to youth and their families
Other relevant experiences in youth development and teen pregnancy prevention
Please describe
I am interested in the:
CAS-Carrera Afterschool Program Model
CAS-Carrera Integrated School Model
Other potential collaborations
Please describe
Please indicate the type funding you are pursuing to support a prospective CAS-Carrera replication and/or collaboration:
Federal (HHS/OAH)
State
Foundation
Agency
Other
Please describe
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