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Salem-Keizer Youth Collaborative
Thank you for your interest in helping meet the needs of our community's children and youth! Please fill out this survey to get a better idea of where you and your church / organization
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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
Phone Number
Area Code
Phone Number
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4
Name of Church / Organization
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5
Your Position or Role You Play in Your Church / Organization
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6
Who is the Main Contact at Your Church / Organization?
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7
Main Contact's Name
First Name
Last Name
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8
Main Contact's Email
example@example.com
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9
Main Contact's Phone Number
Area Code
Phone Number
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10
Are You Interested in Partnering With the Salem/Keizer Youth Collaborative in Helping Meet the Needs of Our Children and Youth?
YES
NO
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11
Is your church / organization already proving or planning to provide a program or activity?
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12
Please describe your program (ages, activities, open to community or only church members, etc)
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13
What Partnership Level(s) Are You Most Interested in Pursuing Right Now?
Opening up space to be used by a single provider/partner who will completely lead and run the program.
Opening up space to be used by a provider/partner while also assisting (providing volunteers, snacks and other resources) the provider in running the program.
Opening up space and completely supervising and running the program.
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14
What Assets and Gifts Does Your Organization Bring to the Table?
(i.e. classroom space, gymnasium, fields, volunteers, financial support, etc)
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15
What School(s) Are You Near?
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16
Are You Currently Partnering With Any Organizations That Work With Children or Youth?
YES
NO
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17
What is the Name(s) of the Organizations You Are Currently Partnering With?
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18
Do You Already Provide Childcare or Youth Programming for Your Neighborhood and Community?
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NO
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19
Is Your Program Licensed or Recorded With the State?
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NO
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20
Who Would You Feel Most Excited to Partner With?
Check All That Apply
Capital Futbol Club (CFC)
Boys & Girls Club
Salem Family YMCA
Salem Child Development Center
Mid-Valley Young Life
Lancaster Learning Center
Marion & Polk Counties
Champions
Satellite Gaming
Salem KROC Center
Valor Mentoring
Other
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21
What Age Group(s) Are You Most Interested in Working With?
0-3
Preschool
K-5
Middle & High School
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22
What Type of Programming Are You Most Interested in Providing?
Child Care
Learning Cohorts During the Day
After-School Programing
Other
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23
Please Describe the Programing You Are Interested In Providing
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24
What Other Questions or Concerns Do You Have?
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25
Would You Like to Have Someone From SLF Personally Follow Up With You?
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