Interest Survey

Organization Information

Items with an asterisk (*) are required

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CEO/Executive Director

Submitted by

Contact Information

State* AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Other

What was your organization's revenue for its most recent fiscal year?*
numbers only, no $ or commas In what year was the organization founded?*

Are you affiliated with a national organization or network?*

No

Yes

If yes, which one?* (200 characters max)

Whom specifically do you serve?

Geographies you work in:* (75 words) Age range of youth you serve:* (200 characters max) Socio-economic demographics* (75 words) Relevant risk factors and characteristics (e.g., aging out of foster care, falling behind in school)* (75 words) Number of youth (age 0-30) you serve annually*
numbers only, no $ or commas What is the social problem facing young people living in poverty you are trying to solve and how are you trying to solve it?* (150 words) How do you plan to grow your organization over the next five years towards solving that problem?* (100 words) What is the evidence of the effectiveness of your work?* (100 words)

My Organization*

…systematically collects demographic and other data on participants.

No

Yes

…systematically collects performance and outcome data.

No

Yes

…has completed an independent, third-party evaluation.

No

Yes

…has completed a 3rd party randomized controlled trial.

No

Yes

Submit

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