Service Provider Form
Welcome! This form gathers the essentials to work smoothly with CORE; contact info, expertise, services, compliance docs, availability, and promotional assets. Your answers help us align expectations, streamline onboarding, and showcase your strengths in our programs.
Organization & Contact
Company Name
*
Legal business or nonprofit name (no abbreviations)
DBA (doing business as)
Company Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Type
*
Please Select
Nonprofit 501(c)(3)
LLC
Corporation
Sole Proprietor
Government
School
Other
Other
EIN/Tax ID
*
(required for vendors/subcontractors; conditional)
Service Regions
Company Website
Vendor/Payee Name (if different)
*
W-9 Form (pdf)
*
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IRS Determination Letter (PDF)
*
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Primary Contact
*
First Name
Last Name
Title/Role
*
Primary Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Partnership Type & Capabilities
How do you want to work with CORE?
*
Please Select
Community
Program Partner
Vendor
Subcontractor
Other
Service Categories
*
Accounting/Tax
Compliance
Workforce Development
Entrepreneurship
Youth Programs
Marketing/Branding
Tech/IT
Logistics/Events
Fundraising/Grants
Procurement/Supply Chain
Other
Service Categories
*
Training/Facilitation
Curriculum Dev
Consulting/Coaching
Creative/Design
Video/Photo
Event Ops
Transportation
Warehousing
Cleaning/Laundry
Printing/Signage
Other
Certifications (check all that apply)
*
WBE
MBE
DBE
SDVOSB
8(a)
HUBZone
State/Local (list)
None
NAICS Code(s) (if known)
Capabilities Overview
*
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Submit your capability statement (PDF)
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Professional Certifications or Licenses
*
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Please list any professional certifications or licenses. Include issuing authority, license number, and expiration details so we can confirm compliance. (PDF)
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Renewals & Conditions
Add any extra expiry/renewal dates and compliance notes we should track (e.g., CEU deadlines, provisional status, county-specific limits).
Program Availability & Format
Delivery Format
*
In-person
Virtual
Hybrid
Willing to Travel?
Yes
No
Weekly Availability
*
Rows
7–11 AM
11 AM–2PM
2–5 PM
5–8 PM
Sunday
Available
Not Available
Available
Not Available
Available
Not Available
Available
Not Available
Monday
Available
Not Available
Available
Not Available
Available
Not Available
Available
Not Available
Tuesday
Available
Not Available
Available
Not Available
Available
Not Available
Available
Not Available
Wednesday
Available
Not Available
Available
Not Available
Available
Not Available
Available
Not Available
Thursday
Available
Not Available
Available
Not Available
Available
Not Available
Available
Not Available
Friday
Available
Not Available
Available
Not Available
Available
Not Available
Available
Not Available
Saturday
Available
Not Available
Available
Not Available
Available
Not Available
Available
Not Available
People & Compliance
Work with youth/minors?
*
Yes
No
For youth-facing roles, can your staff provide current background checks/clearances?
*
Yes
No
General liability active?
*
Yes
No
COI Upload (PDF)
*
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Will you handle participant/client data on CORE’s behalf?
*
Yes
No
Describe how you secure/store personal information (PII).
*
Budget & Commercial
Rate Structure
*
Fixed Fee
Hourly
Unit/Per-Head
In-Kind/Trade
Payment Terms
*
Net 15
Net 30
Other
Remittance Email
*
example@example.com
Remittance Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marketing & Assets
Logo Upload
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(required for partners featured)
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Brand/Usage Notes
*
Any restrictions on name/logo usage
Professional Headshot
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Choose a file
(required for partners featured)
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Approved Bio
*
Approved Description
*
References
Reference:
*
Declarations & Acknowledgments
To your knowledge, do you or your principals have any current conflicts with CORE staff/board or active projects?
*
Yes
No
Describe the conflict
*
Provide names, nature of the conflict, and any mitigation steps.
Policy Acknowledgments
*
I agree to CORE’s Partner Expectations and Brand Use Guidelines.
I understand safety, background, and insurance requirements may apply depending on role.
I consent to the use of my logo/headshot for CORE promotions related to our partnership.
Signature
Authorized Representative Name
*
First Name
Last Name
Title
*
Type a question
*
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: