Approved Provider Setup Form

Approved Provider Setup Form
We’re so grateful for your interest in partnering with Good Soil. This short form helps us get you set up as an approved provider so we can begin supporting the families you serve.
Organization Information
Organization Name
Primary Contact Name
Primary Contact Email
Primary Contact Phone Number
Format: (000) 000-0000.
Website
Services
Type of Organization
Please specify
If you selected Other, please provide more details.
Grade Levels
Do you service families in-person, online, or both?
Payment Information
Preferred Payment Method
Download ACH Payment Authorization Form
ACH Authorization Form

Upload completed ACH authorization form here.
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Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Uploads
W9

Don't already have a completed W-9? Download the blank IRS Form W-9 below, complete and sign it, then upload the completed form.
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Download Blank IRS Form W9
Pricing & Service Information

Upload any pricing, tuition, curriculum, or service information if available.
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Visibility & Listing
Would you like to be listed as an approved provider on our website so families can connect with you?
Agreement
Please review and confirm the following:
- Scholarship funds are distributed directly to approved providers based on student awards and available funding
- Submission of invoices does not guarantee payment and is subject to student eligibility and available funding
- I will provide accurate invoices and only bill for services that have been completed
- I will communicate any changes to services, pricing, or student participation
- I understand that provider approval may be reviewed and updated as needed
Please confirm your agreement:
Should be Empty:

Approved Provider Setup Form

Organization Information

Services

Payment Information

Uploads

Visibility & Listing

Agreement