Partner Application

Thank you for taking the time to complete the Partner Application for Create Now.

You may want to review the application to ensure that you can answer all of the questions before filling it out. The application can't be saved, so if you need to come back to it we recommend that you leave your browser open or complete the application in Microsoft Word and copy and paste your responses.

The application must be submitted online through this form.

After submitting this form you will receive an electronic contract that must be signed in order to complete your partner application.

Thank you again for your interest in partnering with Create Now and we look forward to working with you.

About Your Organization

Name of Facility, Agency or School

Number of Staff

Ratio of youth to staff (EX: 6 youth per 1 staff):

Address

Street Address

City

State

Zip

Phone Number for facility

Fax Number for facility

Website

http://www.YOURAGENCYSWEBSITE.com

Hours of Operation:

Please include hours of operation for weekdays AND weekends.

Choose the main focus of your organization

Services that your Agency, Facility or School Offers: Select all that apply:

Use CTRL to make multiple selections

Describe other services you offer at your facility, agency, or school:

Describe your services. Feel free to include services that were not mentioned above.

Tell us about your arts programs (if any):

Use CTRL to make multiple selections

Describe what arts programs/workshops would be good for your kids?

About Your Clients

How many youth are in your program or facility?

Average Length of Clients' Stay:

DCFS (Foster Youth) Level:

Age Range (Youngest)

Age Range (Oldest)

Gender:

Use CTRL to make multiple selections

Ethnic Breakdown

Please enter the ethnic breakdown of your clients. The total of all of your entries should equal 100%. Enter your breakdown in percentages. If there is an Ethnic group that is not represented enter 0%.

African-American (%)

Please enter a percentage

Caucasian(%)

Please enter a percentage

Native American(%)

Please enter a percentage

Asian American/Pacific Islander(%)

Please enter a percentage

Latino/Hispanic(%)

Please enter a percentage

Multi-Ethnic(%)

Please enter a percentage

Check all the types of youth below that receive your services:

Please note that Create Now serves all the youth listed below. "At-Risk Youth" are defined as disadvantaged kids who come from a relatively normal background and not dealing with any of these challenges.

Describe your clients:

Feel free to include information that was not included in questions above.

About Your Process

Security Clearance Process for mentors/volunteers: Check all that apply

Clearly outline your security/organizational process for bringing on new mentors and volunteers to interact with your youth. For example if there is an orientation, how long is it? When/where does it occur? If there are classes how many are needed? Are there additional security requirements that were not listed above? Please be as detailed as possible.

Are new volunteers required to attend an orientation

Does your organization require a criminal background check or Livescan for volunteers.

Are new volunteers required to pay for a criminal background check with their own money?

If so, how much?

If volunteers are not required to pay for a criminal background check with their own money, just type N/A.

If you have a document that outlines your security/organizational process for bringing on new mentors and volunteers please upload it here.

Availability

Availability for Arts Programs at your agency, facility, or school

Days of Week

Use CTRL to make multiple selections

My clients are available for Arts programs at my agency, facility, or school during the below times

Use CTRL button to make multiple selections.

Availability for Field trips

Days of Week

Use CTRL to make multiple selections

My clients are available for Field Trips at my agency, facility, or school during the below times

Use CTRL button to make multiple selections.

During a fieldtrip would your clients have to adhere to a curfew set by your organization? If so what time?

Please indicate if the curfew is different on the weekends.

Does the organization have transportation?

If yes, what kind of transportation?

Please specify how your clients would get to an event and who would chaperone them.

If you serve families with children can you specify how the families would get to an event and who would chaperone them.

No more than 255 characters

About You

First Name

Last Name

Role/Job Title

Work Number

Mobile Phone

Email Address

Fax

I would prefer to receive notices by:

When working with Create Now I would be the primary contact for

Do you work at this agency or facility on the weekends?

Are you the head director/manager of your agency, school, or facility?

Who would be the primary contact for field trips with your clients?

First Name

Last Name

Role/Job Title

Work Number

Mobile Phone

Email Address

Fax

Is this person the head director/manager of your agency, school, or facility?

When working with Create Now this person would be the primary contact for

Does this person work at the agency or facility on the weekends?

Who would be the primary contact for onboarding new mentors/volunteers that would interact with your clients?

First Name

Last Name

Role/Job Title

Work Number

Mobile Phone

Email Address

Fax

Is this person the head director/manager of your agency, school, or facility?

When working with Create Now this person would be the primary contact for

Does this person work at the agency or facility on the weekends?

Who is the Director of your agency, facility or school? (If you work for a multi-site agency, we would like to know who the director is for your specific location.)

First Name

Last Name

Role/Job Title

Work Number

Mobile Phone

Email Address

Fax

Is this person the head director/manager of your agency, school, or facility?

When working with Create Now this person would be the primary contact for

Does this person work at the agency or facility on the weekends?

How did you hear about Create Now?

Please be specific:

If referred, please provide their name & company. List specific websites, etc.

I am most excited about the following Create Now workshops:

Contact Information