PSN New Member Application

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Point of Contact email* This field is required. Your email address
example@example.com
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Name of organization* This field is required.
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Organization's website URL
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Organization’s social media accounts
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Point of Contact name* This field is required.Your first and last name (should be the same person whose email address is entered in Q1)
First Name
Last Name
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Point of Contact phone number* This field is required.
Please enter a valid phone number.
7
Point of Contact organizational role
8
PSN is prioritizing accepting applicants that are led by folks of color and young people. Who is your organization is led by?* This field is required.Please check all that apply
Majority Gen Z folks
People from frontline and fenceline communities directly and immediately impacted by climate change
Indigenous folks
Black folks
Non-black and non-Indigenous people of color
None of the above
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Type of organization* This field is required.Please check all that apply
Grassroots
Mutual aid group
Student group
Fiscally sponsored organization
501(c)3 non-profit
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Is your organization part of a frontline and/or fenceline community?We define frontline as folks that experience “first and worst” the consequences of climate change. These are predominantly communities of color and low-income, whose neighborhoods often lack basic infrastructure to support them and who will be increasingly vulnerable as our climate deteriorates. This also includes laborers whose daily work or living environments are polluted or toxic. We define fenceline as folks part of a low-income community or community of color that experience an increased health risk due to their community’s proximity to a major source of pollution.
YESNO
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Organizing focusPlease check all that apply
Frontline-focused organization
Youth-focused
Climate/Environment-focused
Migrant justice
International solidarity
Community care/mutual aid
Healing and wellness
Movement support
Reproductive justice
Multi-issue organization
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Groups of people your organization works with:* This field is required.Please check all that apply
Students
Non-student youth
Youth of color, specifically
Community members
13
Which geographic region best represents your organization’s general base?Please check all that apply
Midwest
Southeast
Southwest
Pacific Northwest
Mid Atlantic
Northeast
California
Territories
National
Outside the US
14
Which best reflects the racial diversity of your organization’s leadership?
Black Led
Indigenous Led
POC Led
White/POC Mix
White Dominated
15
Which best reflects the generational diversity of your organization’s leadership?
Multi-Generational
Millennial led (1981-1996)
Gen X led (1965-1980)
Older generation led (born prior to 1965)
Gen Z led (1997-2012)
Movement Elder led
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If your organization is a student group, at which campus(es) are you based?If you work with a multi-campus organization, please list all the campuses where your organization is active.
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Organization’s mission* This field is required.It's OK if your organization doesn't have a one-sentence mission statement. This could also look like principles of unity or values that your organization holds in its organizing practice.
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Number of individuals represented by this organization* This field is required. (approximate number OK)
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Number of paid staff
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Areas that this organization serves* This field is required.This can be a campus, city, region or, if national, simply state “national”
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Why does your organization want to join Power Shift Network?* This field is required. Your response can include what you’d like to get from the network, as well as what your organization could offer to the network (knowledge sharing, trainings, partnerships, etc.)
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How did you hear about Power Shift Network?
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Your organization's logoPlease upload a hi-res square .jpg or .png version of your organization's logo.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please confirm your organization's logo upload* This field is required.
Logo uploaded successfully
The upload failed, so I have emailed our logo to kayla@powershift.org
Our organization has no logo
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Certification* This field is required. By signing, I certify that this organization consists of 5 or more individuals, is committed to Power Shift Network’s mission, vision and values, and embraces Power Shift Network’s guiding principles centered on a justice and anti-oppression framework as outlined in Power Shift Network operating principles. Read through Power Shift Network's mission, vision, and principles here: http://rebrand.ly/PSN-Mission-Vision-Principles
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