Free to Live – Partner Agency Application

Free to Live – Partner Agency Application

Apply to become an official Partner Agency. For organizations, businesses, nonprofits, and service providers interested in advocacy, community outreach, and survivor support. Submissions are reviewed by our leadership team; approved applicants will be contacted for next steps.
Primary Contact Information

Please provide details for the main point of contact at your organization.
Full Legal Name*

First NameLast Name
Title/Role*
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
EmailPhoneText MessageOther
Business Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Organization Information

Tell us about your organization.
Legal Business Name*
DBA (if applicable)
Nonprofit (501c3)LLCCorporationSole ProprietorGovernment AgencyOther
EIN or Tax ID (optional but recommended)
Year Established*
Website
Social Media Handles
Service Area (Cities/Regions Served)*
Services & Community Impact

Share how your organization serves the community.
Describe the services your organization provides.*
What populations do you serve?*
How does your organization align with Free to Live’s mission of advocacy, survivor recovery, and youth empowerment?*
Have you previously partnered with nonprofit organizations? If yes, describe.*
Partnership Interest

Help us understand your partnership goals.
Referral PartnershipResource ProviderProgram CollaborationEvent SponsorshipYouth Program CollaborationCorporate GivingIn-Kind ServicesOther
What can your organization contribute? (Services, volunteers, funding, resources, space, materials, etc.)*
What are you hoping to receive from this partnership?*
Compliance & Credentials

Provide compliance information for liability protection.
YesNo
Upload Business License (if applicable)

Cancelof
Upload Certificate of Insurance (if applicable)

Cancelof
Upload 501c3 Determination Letter (if nonprofit)

Cancelof
Any relevant certifications or credentials

Cancelof
Agreement & Acknowledgments

Please review and acknowledge the following statements.
I certify that the information provided is accurate and truthful.
I understand that submission does not guarantee approval.
I agree to uphold ethical standards aligned with Free to Live’s advocacy and recovery mission.
I understand that any formal partnership will require a written agreement or MOU.
Electronic Signature*
Date*

MonthDayYear
Date
Emergency Contact or Secondary Representative

First NameLast Name
I acknowledge that background checks may be required for staff or volunteers working directly with youth through this partnership.
NoYes (please explain below)
If yes, please explain any potential conflicts of interest.
Should be Empty:

Free to Live – Partner Agency Application

Primary Contact Information

Organization Information

Services & Community Impact

Partnership Interest

Compliance & Credentials

Agreement & Acknowledgments