Directory Application

Note: It may take five to seven business days after you fill out this form before your program or center appears in the online directory.

If you have any questions about this form or encounter any technical difficulties, please contact Connie Casparie at (888) 505-0597 ext. 147 or ccasparie@youth4change.org.

Family Strengthening Basics
The following information will be made public on our website through the searchable Directory of Family Strengthening Organizations.
Program Name:
* Agency/Organization:
Client Contact Name:
Client Contact Title:
Professional Contact Name:
Professional Contact Title:
Email:
Mailing Address:
Street Address:
City:
State/Province:
* County:
ZIP/Postal Code:
Phone:
Fax:
Website:
Program Details
Briefly describe your program:
In what year was your program founded?:
Does your program have special expertise in serving any of the following specific population groups? (Select all that apply):	NOTE: Hold down the CTRL key while making your selection to select more than one option.
What geographic area does your program serve?:
In what 3 top settings are most of your services to families provided? (Select 3):	NOTE: Hold down the CTRL key while making your selection to select more than one option.
Which of the following services does your family support program provide? (Select all that apply):	NOTE: Hold down the CTRL key while making your selection to select more than one option.
Estimate the percentage of those your program serves in each of the following groups:
Native American/Eskimo/Aleut:
Asian or Pacific Islander:
Black/African American:
White/Caucasian:
Hispanic Origin/Latino:
Other:
The information gathered from the remainder of this survey will not be publicly posted to our website. We will use this information to better understand the FRCs we are serving and to improve our services to match the needs of those we serve. We may report this information in aggregate to funders and other interested parties.
How many families do you serve annually? (If uncertain, give your best estimate):
Do you have a specific target population? If so, please describe:
What population do you serve?:	NOTE: Hold down the CTRL key while making your selection to select more than one option.
What percentage of your service population cannot read or write in English?:
In any language?:
What percentage of your service population is low-income?:
What percentage of your service population is middle-income?:
What percentage of your service population is upper-income?:
Do you have eligibility requirements?:
If you have eligibility requirements, complete the following statement. We have eligibility requirements because of: (Select all that apply):	NOTE: Hold down the CTRL key while making your selection to select more than one option.
What are the ages of the children being served by your program?:	NOTE: Hold down the CTRL key while making your selection to select more than one option.
What is the number of paid full-time equivalent (FTE) employees on your staff? (Two half-time workers = one FTE):
Do you use volunteers? If yes, how many?:
Do you intentionally hire professionals and paraprofessionals from your community? If so, what percentage of staff are former program participants?:
How does your program provide staff training/development?:	NOTE: Hold down the CTRL key while making your selection to select more than one option.
Does your program operate according to the Principles of Family Support Practice? (Below):
Principles of Family Support Practice Staff and families work together in relationships based on equality and respect. Staff enhance families' capacity to support the growth and development of all family members - adults, youth, and children. Families are resources to their own members, to other families, to programs, and to communities. Programs affirm and strengthen families' cultural, racial, and linguistic identities and enhance their ability to function in a multicultural society. Programs are embedded in their communities and contribute to the community-building process. Programs advocate with families for services and sy stems that are fair, responsive, and accountable to the families served. Practitioners work with families to mobilize formal and informal resources to support family development. Programs are flexible and continually responsive to emerging family and community issues. Principles of family support are modeled in all program activities, including planning, governance and administration.
Has your program participated in a self-assessment?:
Have your program's service components been independently evaluated?:
Has your organization been part of a peer review process?:
Does your program have regular internet access?:
Do you give consumers internet access at your program/center?:
As an organization, we're interested in providing assistance to family resource centers and family support programs. What are the top three subjects in which your program/center could use technical assistance, training, or printed information? (Select 3):	NOTE: Hold down the CTRL key while making your selection to select more than one option.
Does your program receive funding from any of the following sources? (Select all that apply):	NOTE: Hold down the CTRL key while making your selection to select more than one option.
What is your program's annual budget?:
Organization Details
Is your program part of a larger organization?:
If yes, what is the name of this organization?:
Organization Contact:
Organization Phone:
Organization Website:
Organization Email:
Collaborative/Network Details
Is your program part of a formal collaborative or network?:
If yes, what is the name of the collaborative or network?:
Collaborative/Network Contact:
Collaborative/Network Phone:
Collaborative/Network Website:
Collaborative/Network Email:
Is the collaborative/network:
Are there other family support centers in this collaborative/network?:
How is the collaborative/network funded?:	NOTE: Hold down the CTRL key while making your selection to select more than one option.
Other
Is there anything else you want us to know about your program or a particular area of expertise you have?:
How did you hear about this survey?:

* Required

Adults with developmental disabilities
Cultural competency/diverse populations
Children with developmental disabilities
Elders
Families involved with child protective services
Families with special needs (including health/mental health)
Fathers
Foster Parents
Gay/lesbian parents
Grandparents
Homeless families
Incarcerated parents and their families
Immigrants
Managing traumatic stress
Military families
Parent leadership and engagement and/or training
Single parents
Teen parents
Teens (ages 13-18)
Youth (ages 6-12)
Other

Adult education
Adult health care
Adult literacy
Child abuse prevention with families identified as at-risk or identified to child welfare system
Child care: before and after school
Child care: during programmatic activities
Child care: full-time
Child development activities
Community building activities
Counseling or mental health services
Crisis relief services
Domestic violence services
Early childhood family education
Emergency assistance with basic needs
Engaging fathers
English language skills or English Language Development (ELD)
Faith-based services
Family literacy
Family/parent leadership training
GED courses
Health education
Home visiting
Hotline or warmline
Housing services
Information and referral
Job counseling or placement
Job training
Legal services assistance
Life skills training
Parent engagement in policy and advocacy
Parent-child activities
Parenting education
Pediatric and adolescent health care
Peer support (support groups; mentoring)
Respite care/Crisis care
School readiness
Substance abuse counseling/treatment
Support for families with special needs
Teen parenting
Toy and/or book lending library
Transportation
Traumatic stress/grief counseling
Youth Development Activities (ages 13-18)
Youth Development Activities (ages 6-12)
Other

Accreditation
Adoption
Adult education
Advocacy
At-risk families
Child abuse and neglect
Child care
Child development
Community development
Community organizing
Community safety
Cultural responsiveness
Cultural competency/diverse population
Domestic violence
Early childhood education
Economic development
Elders
Employment
Evaluation
Family assesment
Family involvement/leadership
Family support
Fathers/fatherhood
Foster families
Fundraising
Gay/lesbian families
Health
Home visiting
Homelessness
Hotlines/warmlines
Housing
Immigrant families
Incarcerated parents
Information and referral
Information technology
Life skills education
Literacy
Mental health
Multigenerational/grandparents
Parent/child activities
Parent education
Parent leadership and engagement
Public policy
Reform/integration
Respite care
Rural families
School-linked services
School readiness
Special needs/disabilities
Staff development
Substance abuse
Support groups
Technology
Teen pregnancy
Welfare reform
Work and families
Youth
Other

Federal government (directly from federal sources)
State government (through federal grants)
State government (directly from state sources)
California Department of Social Services Office of Child Abuse Prevention
First 5/Children and Families Commission
Local government
Promoting Safe and Stable Families (Title IVB)
Center for Substance Abuse Prevention (CSAP)
National Center for Injury Prevention and Control (NCIPC)
Temporary Assistance for Needy Families (TANF)
Foundation grants
Fee-for-service work
Individual contributions or donations
Corporation or business sponsorship
Title II of CAPTA Community Based Child Abuse Prevention Program (CBCAP; formerly CBFR)
Child Abuse and Prevention Treatment Act (CAPTA)
Social Service Block Grants (SSBG)
Title XIX Medicaid
Office of Justice Programs (OJP)
United Way
Other