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.
Preferred Method of Contact

Other
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)
Type of Organization

Other
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.
What type of partnership are you seeking?

Other
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.
Are you licensed, certified, or insured where required by law?
Upload Business License (if applicable)

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Upload Certificate of Insurance (if applicable)

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Upload 501c3 Determination Letter (if nonprofit)

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Any relevant certifications or credentials

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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
Background check acknowledgment (required if your representatives will work directly with youth): I acknowledge that background checks may be required for staff or volunteers working directly with youth through this partnership.
Conflict of Interest Disclosure: Do you or your organization have any relationships, financial interests, or affiliations that could present a conflict of interest in partnering with Free to Live?
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