Referral Partner Agency Request
This application DOES NOT GUARANTEE ACCEPTANCE. There is a wait list and you will be contacted when we have room to add a new partner. NOTE THIS FORM IS FOR AGENCIES NOT AGENCY WORKERS! If you are a new worker from one of our agency partners and need to be added to your agencies list of workers email d.huff@oyatetipi.com
Name of Organization:
*
Contact Person:
*
Executive Directors name
*
Address of Organization:
*
Street Address
City
Province
Postal / Zip Code
Agency website
*
Phone Number
*
E-mail
*
example@example.com
Type of organization
*
Indigenous
Indigenous lead
Non-Indigenous
What is your agency's mission statement?:
Which communities do you serve?:
Would your agency be willing to refer community members outside of your programs offered?
How many clients/community members do you anticipate sending to us each month?
Please verify that you are human
*
Submit
Should be Empty: