Become a Partner
Thank you for your interest in becoming a partner with REACH. The following application is to learn about your agency, how it fits within our mission, the initiative that is seeking support, point of contact, and approved members of your group. Once the application is reviewed, a member of the team will reach out to the designated point of contact. This submission allows your agency, it's approved initiative, and select members to make requests for special event supports. Requests for resources must be submitted at least 2-4 weeks in advance of your desired pick-up date. Please direct all questions to Jennifer Goff at jgoff@reachreads.org.
Agency Information
Please complete the section to best describe your agency
Agency/Organization Name
If you have a DBA, please include this as well.
CEO/ President/ Executive Director/Principal, etc.
*
Prefix
First Name
Last Name
Suffix
Type of Agency (Select all that apply)
Public/ Government
Non-profit/501(c)3
Private/for-profit
Public School
Private School
Title I school
Other
Agency Website
Address of Agency (Main office/Location)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Agency was Established:
# of FT Staff
# of PT Staff
# of volunteers
# of board members
Agency Mission and Vision Statement
Total Operating Budget for most recent fiscal year
How will collaborating with REACH enhance your initiative?
Primary Contact Information
Please complete this section so we may follow-up with the appropriate person regarding your request. Please note this person will be our direct contact for all questions regarding this initiative.
Name of person completing this form
*
Prefix
First Name
Last Name
Suffix
Role within Agency (Title)
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Initiative Information
We may partner with agencies through a variety of initiatives and due to this, we ask each agency submit a partnership application for each initiative. For example, Agency A has family liaisons at various locations that provide various events and supports throughout the school year. Agency A would need to submit a Partner Application for their Family Liaisons initiative, along with a list of "approved" individuals able to make requests. Agency A may also have a Books on Bike program that with a different overall purpose/function and would need it's own application. Another example would be a Foodbank that has various initiatives and different points of contact based on each. Each initiative would create an application with approved members so REACH can best serve our community (Backpack program vs. healthy school marketplace vs. Friday distributions)
Program/Initiative name
Name of Program/Initiative.
Brief Description of Event/Project
Location of Event
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you requesting REACH Inc. be present at this event?
Yes
No
If you answered "Yes" to the previous question, what are you requesting REACH Inc, representatives to do at this event?
Is this a collaborative program/initiative?
Yes
No
If this is a collaborative program/initiative, please identify key partners.
Example: Partnership between your agency and Agency X who is hosting the event.
Is this a one time event, or a repeating event? If it's one time, the start and end date below should be the same date
One time
Repeating
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Start Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
End Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Total # of people you project to serve
Which of the following best fits your request? (select all that apply)
I am requesting new books (may have a fee for service and/or requirement for reporting)
I am requesting gently loved books
Other
Total number of books requested
If this is an application for a repeating event, how often will you be needing books?
Once a week
Once a month
Every other month (bi-monthly)
Every third month (quarterly)
Once a year (annually)
If you are requesting a combination of new and used books, please specify below how many of each:
Number of people you project to serve by area with this event/project
Rows
Projected #
Chesapeake
Norfolk
Portsmouth
Isle of Wight
Suffolk
Virginia Beach
Newport News
Hampton
Williamsburg/Jamestown
Poquoson
Yorktown
Eastern Shore
Other
Population(s) you project to serve by area with this event/project
Rows
Projected #
English as a Second Language
Expectant parent
General Population
Justice-Involved
LGBTQIA
Low-Income
ALICE (Asset Limited Income Constrained Employed)
Medically Underserved/Chronic Disease
Homeless/Displaced/foster care
People with Disabilities
Survivors of abuse/violence
Veterans/Military Families
Women
Total
Age break down of the population being served (projected)
*
Rows
Ages 0 - 3
Ages 4-7
Ages 8-12
Ages 13-16
Ages 16-18
Ages 19-25
Ages 25-65
65+
Unknown
Population #
Race/ Ethnicity break down of the population being served (projected)
*
Rows
African American/ Black
Asian/Pacific Islander
Caucasian/ White
Hispanic/Latino
Native American
One or more
other
Race (%)
Which of the following best options best fits your request?
I am requesting books for the event
I am open to either options
Other
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Reporting and Promotion
Please answer each question to the best of your ability. Your answers will be used to understand if/how we can support your event-- as well as how you can support our organization's mission and vision!
Is your agency willing to submit demographic information to REACH for EACH child served through our support? (Name/ID, age, grade (if available), race/ethnicity, sex, etc.)
Yes
No
I'm unsure
Other
Will your event have a post event survey?
Yes
No
I'm unsure
Other
If yes, is your agency willing to add question/s regarding our support, as well as share the results of the survey?
Yes
No
I'm unsure
Other
Is your agency willing to participate in a REACH follow-up questionnaire regarding the impact of your event, the impact of the support, and how we can improve in the future?
Yes
No
I'm unsure
Other
Is your agency willing to pick-up all necessary items from the REACH office to successfully facilitate your event?
Yes
No
I'm unsure
Other
Is your agency willing tag, share, and cross promote our partnership through your listservs, emails, social media, etc.? (terms to be discussed once awarded support)
Yes
No
I'm unsure
Other
Is your agency willing to sign and uphold a mutually agreed upon MOU, if needed?
Yes
No
I'm unsure
Other
Is your agency willing to provide financial compensation for services rendered to help us continue to carry out our mission?
Yes
No
I'm unsure
Other
I understand that the submission of this form does not equate to approval. I am aware someone from the REACH staff will reach out to me after my submission.
yes
no
Submit
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