• Treatment Center Partners

    The Mattern Foundation is a 501(c)(3) tax-exempt non-profit organization. As a private foundation, we are required to collect certain information from non-profit organizations and for-profit treatment centers who receive payments or grants from the Foundation. Please complete the organizational partner application and upload requested supplemental materials.

  • Organization Identification

  • Format: (000) 000-0000.

  • Legal & Tax Status

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  • Licensure & Accreditation

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  • Accrediting body (select all that apply)*
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  • Has your organization had any current or past licensure actions, complaints, or sanctions?*

  • Clinical Program & Staff

  • What levels of care does your program offer?*
  • What clinical staff are on site or accessible as needed?*
  • Are individualized treatment plans developed for each patient?*
  • Is Medication-Assisted Treatment (MAT) offered?*
  • Is Co-occurring mental health treatment offered?*

  • LGBTQ+-Affirming Culture

  • Does your organization have a written non-discrimination policy inclusive of sexual orientation and gender identity in place?*
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  • Is LGBTQ+ cultural competency training required for clinical staff?*
  • Does your organization have experience serving gay and bisexual men?*
  • Does your organization have experience serving people affected by chemsex or party-drug use?*
  • Do you offer LGBTQ+ peer support groups?*
  • Are LGBTQ+-identified staff currently in clinical or leadership roles*

  • Financial & Operational

  • What payment options does your organization accept?
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  • Has your organization had any pending litigation, bankruptcy, or licensing board action in the past 5 years?*

  • References & Prior Relationships

  • Has your organization received grants or funding from other foundations?*
  • Does your organization have any existing relationship with The Mattern Foundation, including the Board of Directors, Founder, or CEO*

  • Payment Setup

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  • Certification & Signature

  • Date*
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  • Should be Empty: