Community Partner General Application

Organization Information

Organization Name*

Mailing Address*

Mailing Address

City

State/Province

Zip/Postal

What is the vision and mission of your organization? *

What are your organizational values?

Contact Information

Primary Contact Name*

Primary Contact Title (e.g. Director, Coordinator, etc.)*

Primary Contact Phone Number*

Primary Contact Email Address*

Preferred Contact Method*

Phone

Email

I do not have a preference of contact method.

If applicable, please provide the social media handles for your organization (e.g. @HopkinsCSC for Facebook and Instagram)

Staff and Funding

Is your organization 501(c)(3) certified?*

Yes

No

Is your organization fiscally sponsored?*

Yes

No

If "yes", who is your fiscal sponsor?*

What is your organization’s annual operating budget?*

If possible, please specify percentages.

Can your organization provide proof of general liability insurance/certificate of insurance?*

Yes

No

Please explain why your organization cannot provide proof of general liability insurance/certificate of insurance?

Please detail staff titles, employment status (full-time vs. part-time, exempt vs. non-exempt), and general demographic information. *

Programs/Initiatives and Community Impact

What programming or initiatives does your organization offer? *

Which neighborhood(s) in Baltimore City do you serve? Note: The Center for Social Concern works exclusively in Baltimore City. *

How are community members a part of decision-making processes regarding program design, implementation, and assessment? *

How does your organization evaluate community impact? If available, please attach your organization’s most recent impact report below.*

Please upload your most recent impact report here.

Maximum upload size: 2.1MB

Partnership Information

How can the Center for Social Concern be a valuable partner? What specific needs can we address? Please be as exhaustive as possible, as we are hoping to use this information to match you most effectively to our programming/various initiatives. *

What are resources and/or assets that you are willing to offer our students and the University at large (e.g. space rental, student mentorship, training, etc.)? *

University Affiliations

Have you worked with the Johns Hopkins University before? *

Yes

No

If yes, in what capacity? If known, please note the department(s)/office(s), program(s), and/or point(s) of contact. Please also describe the project/initiative in as much detail as possible and current status.*

Have you worked with the Center for Social Concern before? *

Yes

No

If you selected "other", please specify.*

Please specify how long you've worked with these programs.*

Would you like to be added to our mailing list?

Yes, sign me up

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