Coalition of Community Foundations for Youth

Membership Application

Section A: Contact Names

Community Foundation
Foundation Name:
Chief Executive:
Primary Contact:
Address:
Phone:
Fax:
Primary Partnership Contact
____ Check here if same as Community Foundation primary contact
Name:
Organization:
Address:
Phone:
Fax:
Alternate phone:
Internet/E-mail Address:

Please attach a list of any other partnership contacts who should be on our mailing list.

Section B

As a member of the Coalition, we understand that we will be eligible to receive technical assistance through the national conference series and various technical assistance and capacity-building grants programs. We also understand that ongoing assistance from the Coalition's national staff and peer coaching to serve as a problem-solving resource are available, including connecting experienced community foundations with communities that may be at an earlier stage of development. The conferences are free of charge to members, and there is no membership fee for joining the Coalition.

In return, we agree to: (1) endorse the Coalition's mission statement (to be signed by community foundation CEO on reverse side of this application); (2) assign a staff person to serve as the primary contact with the Coalition; and (3) provide baseline information to the Coalition upon application and annually thereafter outlining our community foundation's commitments, financial and otherwise, to children, youth and family issues, and describing successful approaches and lessons learned.

Return this form to:

Coalition of Community Foundations for Youth
P.O. Box 489
Excelsior Springs, MO 64024-0489
Phone: (913) 713-6111
Fax: (816) 407-6212
E-mail: ccfy@ccfy.org