NGO Partner - Kit Requests Form
Please complete all questions about your organization, the children and youth you serve, and how Creativity Kits would be distributed and used.
Organization Information
Organization name
*
Organization website
Primary contact name
*
First Name
Middle Name
Last Name
Title / role
Email
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City
*
State
*
Year organization was established
*
What type of organization are you?
*
Please Select
501(c)(3) nonprofit
Other registered nonprofit/NGO
School or educational organization
Healthcare organization
Faith-based nonprofit
Other
EIN or nonprofit / charitable registration number
Briefly describe your organization’s mission and primary programs
*
Service Reach and Population
Approximately how many children and youth does your organization serve each year?
*
Please Select
Fewer than 100
100–499
500–999
1,000–4,999
5,000+
How long has your organization been providing direct services to children or youth?
*
Please Select
Less than 1 year
1–3 years
4–10 years
More than 10 years
What age groups do you primarily serve?
*
Under 6
6–10
11–14
15–17
Which circumstances are common among the children and youth you serve?
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Family separation/divorce/foster care/family instability
Abuse/neglect/domestic violence
Serious illness/hospitalization/health-related trauma
Grief/loss
Mental/emotional health challenges
Poverty/housing instability
Exposure to community violence/disaster
Involvement with child welfare/juvenile justice system
Other
If you selected "other" above, please provide a brief description:
Approximately what percentage of the young people you serve are experiencing one or more of these circumstances?
*
Please Select
Less than 25%
25–49%
50–74%
75–100%
Kit Request and Intended Use
Approximately how many Creativity Kits are you requesting?
*
Is this an annual number, or how long will your requested number of kits last?
How would the kits be used?
*
Given directly to children/youth during a crisis/difficult circumstance
Incorporated into an existing program
Used in counseling/wellness/therapeutic-support activities
Used in a hospital/healthcare setting
Used in a residential/shelter/foster-care setting
Used in school-based/after-school programming
Other
If you selected "other" above, please provide a brief description:
Who would typically provide the kit to the child or young person?
*
Counselor/therapist
Social worker/case manager
Healthcare professional
Teacher/educator
Program staff
Volunteer
Parent/caregiver
Other
If you selected "other" above, please provide a brief description:
Does your organization have staff or trained volunteers who would oversee distribution of the Creativity Kits?
*
Please Select
Yes
No
Tracking, Feedback, and Program Fit
Does your organization currently track participation or outcomes for the children and youth you serve?
*
Please Select
Yes, regularly
To some extent
No
Would your organization be willing to provide brief feedback about how the Creativity Kits were used and their perceived benefit?
*
Please Select
Yes
Possibly
No
Would you be willing, when appropriate and with proper permissions, to share anonymous participant feedback, stories, or observations that could help us improve the program?
*
Please Select
Yes
Possibly
No
Why do you believe Creativity Kits would be helpful to the children or youth you serve?
*
Is there anything else we should know about your organization or the population you serve?
How did you hear about the Creativity Kit program?
Submit
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