Dignity Grows Hartford Hope In A Bag Interest Form

Hope In A Bag Program Interest Form

Hartford, CT Chapter
For organizations interested in partnering with Hope In A Bag, this form allows us to learn more about your work and the communities you serve. Submitting the form adds your organization to our partner waitlist and helps our team understand where support is most needed as resources allow.

Organization Information
Organization Name:*
Program Name (If applicable):
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Organization:*

Food Pantry/Meal ServiceSchools K-12 & Higher EducationTransitional Housing/Shelters/Domestic Violence Safe HavenYouth Empowerment/After-School ProgramsMunicipal or City ServiceMedical Facilities & ClinicsLGBTQ+ Support CentersOther
How many clients do you anticipate serving monthly?*

0-2020-5050-100Over 100
How many clients do you anticipate serving monthly?*

0-2020-5050-100Over 100
How often do your clients request/mention a need for menstrual hygiene products (maxi pads, tampons, etc)?*

NeverInfrequentlyOccasionallyFrequently
How often do your clients request/mention a need for menstrual hygiene products (maxi pads, tampons, etc)?*

NeverInfrequentlyOccasionallyFrequently
How often do your clients request/mention a need for general hygiene products (soap, shampoo, deodorant)?*

NeverInfrequentlyOccasionallyFrequently
How often do your clients request/mention a need for general hygiene products (soap, shampoo, deodorant)?*

NeverInfrequentlyOccasionallyFrequently
Authorized Representative Information
Name:*

First NameLast Name
Title/Role*
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Signature*

Clear
Please verify that you are human*
Should be Empty:

Hope In A Bag Program Interest Form