Service Provider Form

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.
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Type*
Other
EIN/Tax ID*
(required for vendors/subcontractors; conditional)
Service Regions
Company Website
Vendor/Payee Name (if different)*
W-9 Form (pdf)*

Cancelof
IRS Determination Letter (PDF)*

Cancelof
Primary Contact *

First NameLast Name
Title/Role*
Primary Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Weekly Availability *

People & Compliance
Work with youth/minors?*

YesNo
For youth-facing roles, can your staff provide current background checks/clearances?*

YesNo
General liability active?*

YesNo
COI Upload (PDF)*

Cancelof
Will you handle participant/client data on CORE’s behalf?*

YesNo
Describe how you secure/store personal information (PII).*

Declarations & Acknowledgments
To your knowledge, do you or your principals have any current conflicts with CORE staff/board or active projects?*

YesNo
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.