Listen4Good Premium Registration Form

Thank you for your interest in participating in Listen4Good (L4G) Premium. Please review this page for more information about our participation guidelines and to help you determine whether L4G meets your needs. After we review your information, we may contact you for more details prior to finalizing your registration.

If you have any questions regarding this form, please contact L4G at hello@listen4good.org.

This registration form has the following sections:

A. Organization Information

B. Contact Information

C. Organizational Mission and Learning Goals

D. Payer Information

E. Additional Organization Details

F. Wrap-Up

This form does not automatically save your progress. If you are not able to complete this form in one sitting, click on the “Save my progress and resume later” button on the top or bottom of the page you are on.

What is the email of the person filling out this registration form? Once submitted, a copy of the response will be sent to that email:

Which Listen4Good cohort are you registering for? You can review this timeline for an overview of the L4G start and end dates and suggested timelines for progressing through the program.

Listen4Good’s January cohortListen4Good’s July cohort

A. ORGANIZATION INFORMATION

Organization's legal name:

Publicly used name (doing business as) if different than above:

Street address:

City:

State:

Zip code:

Website URL:

Is your organization a U.S. 501(c)3 public charity or government agency?

Yes, we are a 501(c)3 public charityYes, we are a government agencyNo, we are not a 501(c)3 public charity or government agency

Annual budget:

$

Please round to the nearest whole number and do not include commas.

Total number of full-time staff that work in your organization:

B. CONTACT INFORMATION

Project Manager for L4G Implementation

The Project Manager will be responsible for overall project management and implementation of L4G, data analysis, and management of staff and client relationships to this work. If you don't know who will serve as the Project Manager yet, please include the primary contact for this registration.

Project Manager First Name:

Project Manager Last Name:

Project Manager Title:

Project Manager Email Address:

Project Manager Phone Number (###-###-####):

Project Champion

The Project Champion, typically a senior leader or manager in the organization, will be responsible for change management and tying feedback to ongoing organizational initiatives.

The Project Champion is:

The same person as the Project ManagerA different staff member of the organization

Project Champion

Project Champion First Name:

Project Champion Last Name:

Project Champion Title:

Project Champion Email Address:

Project Champion Phone Number (###-###-####):

The overall time commitment for the person managing an organization’s Listen4Good project is, on average, 8-10 hours per month over the 18-month period. This includes participating in Listen4Good group webinars, meeting with your coach, and working with colleagues on survey development, administration, analysis, etc. (See example program timeline here). Note that every organization is different and the work ebbs and flows, so workloads may differ from the average. How does that sound to you?

My organization is able to make the time commitment described above.Other (please explain below)

C. ORGANIZATIONAL MISSION AND LEARNING GOALS

The following questions help us understand your organization and how you will use L4G.

Please give a brief description of your organization's mission and activities. (150 words or less)

Which of the following issue areas best represents the core activities and services of your organization? (Click here for additional information about selecting your organization’s issue area.)

Issue Area Category:

Issue Area Sub-category:

Which of the following best describes your organization’s model for service delivery? (Select one. If your organization has mixed models, select the one that defines your program(s) best.)

Cohort (clients/participants interact with the organization and consistent peers for an extended period of time, often on a regular cadence — e.g., training classes, residential living facilities, leadership development program(s))One time drop in (clients/participants engage only a few times and have no continual relationship with the organization — e.g., emergency shelters, phone-based help line, one-time training(s))Repeated drop in (clients/participants interact for an extended period of time but on an irregular cadence — e.g., food banks, health clinics)

Please describe the clients you serve, including a breakdown of their race/ethnicity makeup if you collect it. (150 words or less)

Why are you interested in participating in L4G? What are the 2-3 things you hope to learn by gathering feedback through L4G? (200 words or less)

What program would you like to survey first? Tell us a bit about the program (what services are provided, how clients interact with the organization, etc.). (150 words or less)

As a survey-based approach, Listen4Good is best for programs that serve enough clients to produce a meaningful number of responses. Approximately how many clients do you anticipate the above-mentioned program will serve this year?

The L4G survey includes core benchmarked questions as well as opportunity to customize additional questions. Do Listen4Good’s core survey questions (see below) feel appropriate for your program? (Click here for Listen4Good’s detailed client survey template.)

1. How likely is it that you would recommend {…} to a friend or family member?

2. What is […] good at?

3. What could […] do better?

4. Overall, how well has […] met your needs?

5. How often do staff at […] treat you with respect?

Yes, Listen4Good’s core survey questions feel appropriate for my programNo, Listen4Good’s core survey questions do not feel appropriateI'm not sure

For organizations who have previously participated in L4G — why did your organization decide to participate again?

This is our organization's first time participating in L4GWe participated again because... (please describe below)

D. PAYER INFORMATION

Please provide basic information on who will be paying for the $6,000 fee to fund your participation in L4G. Note that by listing a funder you are allowing us to directly contact the payer and solicit payment from them. If you plan to pay out-of-pocket, please note that below.

Who will be paying for your participation in L4G?

A funder will be paying on behalf of my organizationMy organization will pay out-of-pocket

Funder organization and billing contact

Funder organization name:

Billing contact:

First name of billing contact:

Last name of billing contact:

Contact title:

Contact email address:

The billing contact for our organization is:

Organization's billing contact:

First name of billing contact:

Last name of billing contact:

Contact title:

Contact email address:

Listen4Good Premium Registration Form

A. ORGANIZATION INFORMATION

B. CONTACT INFORMATION

C. ORGANIZATIONAL MISSION AND LEARNING GOALS

D. PAYER INFORMATION

E. ADDITIONAL ORGANIZATION DETAILS

F. WRAP-UP