Program Registration Form

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Thank you for your interest in participating in Listen4Good (L4G). 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.

Note that some information may be pre-filled from previous registration(s) your organization has completed. Be sure to review all pre-filled data and correct any that has changed.

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

First Name:

Last Name:

Email:

Which L4G 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.

July 2023 Online+July 2023 PremiumJanuary 2024 Online+January 2024 Premium

A. ORGANIZATION INFORMATION

Organization's legal name:

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

Country:

Street address:

City:

State/Outlying Territories or Province:

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 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 L4G project is, on average, 8-10 hours per month over the 18-month period. This includes participating in L4G 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)

D. PAYER INFORMATION

Please provide basic information on who will be paying for the 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 name:

The billing contact for our organization is:

First name of billing contact:

Last name of billing contact:

Contact title:

Contact email address:

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