ReCharged Community Partner Interest Application
Share your organization details and how you’d distribute Community Passes to parents you serve—approval doesn’t guarantee passes.
Organization & Contact Information
Organization / Community Group Name
*
Primary Contact Full Name
*
First Name
Middle Name
Last Name
Title / Role
*
Email
*
example@example.com
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
City / State
*
ZIP Code
*
Website
Instagram / Social Handle
Organization Profile
Organization type
*
Church/Faith Community
School/Education Organization
Nonprofit
Parent/Family Organization
Community-Based Organization
WIC/SNAP or Family Resource Programi
Healthcare/Wellness Organization
Government/Public Service Organization
Neighborhood/Civic Group
Independent Community Leader/Organizer
Other
Briefly describe your organization or community work
*
Community Reach
Who do you primarily serve?
*
Parents/Families
Expecting/New Parents
Single Parents
Co-Parents
Fathers
Mothers
Parents of Children with Disabilities/Special Needs
Foster/Adoptive Families
Grandparents/Kinship Caregivers
Low-Income/Resource-Limited Families
Black/Brown/Minority Families
LGBTQ+ Parents/Families
Caregivers/Sandwich Generation
Families Navigating Grief/Loss
Other
Approximately how many parents/families do you directly reach?
*
Please Select
Under 25
25–49
50–99
100–249
250–499
500–999
1,000+
Not sure
What geographic communities or ZIP codes do you serve?
*
Community Pass Need
How many Community Passes would you ideally need?
*
Would a partial allocation still be helpful if fewer passes are available?
*
Yes
No
Please contact me to discuss
Distribution & Impact
How would your organization identify or distribute Community Passes to parents in the community?
*
Why would access to ReCharged be meaningful for the parents and families you serve?
*
Distribution Readiness
Could your organization distribute passes promptly once allocated?
*
Yes
No
Need more information
Can your organization provide a primary point of contact for distribution and recipient questions?
*
Yes
No
Partnership Interests
Would your organization be willing to help share ReCharged beyond Community Pass distribution?
Yes
Maybe
No
If yes or maybe, which outreach methods could your organization support?
Email/newsletter
Social media
Community meetings/events
Printed flyers/materials
Direct parent outreach
Other
Is your organization interested in sponsorship or other partnership opportunities?
Yes
No
Maybe
Anything else the ReCharged team should know about your community or request
Community Give-Back
Want to pour back into another family? Community partners may choose to sponsor or donate a small block of 5 Community Passes that ReCharged can award to families in need through our direct Community Pass request process. This is completely optional, separate from your organization’s own requested allocation, and does not increase or guarantee the number of passes your organization receives.
Would your organization be interested in sponsoring 5 additional Community Passes for families outside of your own allocation?
Yes
Maybe / send me details
Not at this time
Submit Community Partner Application
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