Page 8 - Faith-based Presentation(pt.2-train).pptx

Faith-based Partnership Form
Organization Name: __________________________________________________________________ Address: ___________________________________________________________________________ City/State/Zip: _______________________________________________________________________ Phone: _____________________________________________________________________________ Fax: _______________________________________________________________________________ Email: _____________________________________________________________________________ Organization Representative(s):
1. ____________________________________________ Title: ________________________________ 2. ____________________________________________ Title: ________________________________
PLEASE CHECK TYPE OF SERVICES OR MINISTRIES THAT YOUR FAITH-BASED ORGANIZATION OFFERS (please check all that apply):
__ Employment /Training __ Education
__ Job Preparation
__ Counseling
__ Skills Training
__ Support Services __ Mentoring/Tutoring __ Poverty Programs
__ Military Programs
__ Missions
__ Child Care
__ Family Services
__ Senior Services
__ Re-entry Ministries
__ Health Fairs/Education __ Homelessness/Shelter
__ Conferences
__ Youth Ministries
__ College programs
__ Food/Clothing
__ Disability Programs
__ Ministry Training
__ Fatherhood
__ Other: ________________
PLEASE CHECK TYPE OF FAITH-BASED PARTNERSHIP THAT YOU WOULD LIKE TO OFFER TO YOUR CONGREGATION AND COMMUNITY:
Workforce
__ Apprenticeship
__ Internships
__ Job shadowing
__ Clinical Experience __ Direct Hire
__ Business Instruction __ On the Job Training
Health & Wellness Caregiver Support
__ In Store Consultation __ Pharmacy services __ Health Education
__ Heath Screening
__ Health Fairs __ Flu Clinics
__ Project Health
__ Information & Resources __ Caregiving skills
__ Stress and self-care
__ Respite resources
__ Caregiver education __ Emotional support __ Caregiver ministry
__ Other: Please specify: ______________________________________________________________
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