FPWA New Member Application
Please complete all requested fields to ensure successful completion of your new membership application.
Applicant Contact Details
First Name
Last Name
Title
E-mail
Organizational Demographics
Organization Name
EIN Number
Year of Incorporation
Annual Budget ($)
Number of Individuals Served Per Year (Est.)
Billing Street
Billing City
Billing State/Province
Billing Zip/Postal Code
Organizational Phone Number
Organizational E-mail
Website
Services Provided (check all that apply by holding 'left ctrl' on your computer)
Please select...
Adoption
Adult Education
After-school/OST
Arts and Culture
Camp (Sleep-away and Day)
Child Care, Early Education
Child Welfare/Preventive
Client Advocacy
College Access/Career Counseling
Community Organizing
Criminal Justice
Crisis Intervention
Disability Services
Domestic Violence
Education (in-school)
Feeding Program
Financial Assistance
Financial Empowerment
Foster Care
Health Care
HIV/AIDS
Home Care
Homeless Prevention
Housing and Community Development
Immigrant Services
Information Referral
Juvenile Justice Services
Legal Services
Mental Health
Nutrition Education and Services
Older Adult/Senior Services
Other
Policy Advocacy
Public Benefits/Facilitated Enrollment
Re-Entry Services
Residential Services/ Supportive Housing
Small Business Development
Substance Abuse Services
Veterans Services
Workforce Development
Youth Services
In which of the following boroughs do you provide services? (Select all that apply)
Please select...
Manhattan
Brooklyn
Bronx
Queens
Staten Island
IRS 501(c) 3 Determination Letter
One-Pager Highlighting Mission and Work of the Organization
Most Recent Annual Budget
If Available, Most Recent Audited Statement
Other Organizational Memberships/Affiliations (
check all that apply by holding 'left ctrl' on your computer
)
Please select...
Asian American Federation
Association of Neighborhood and Housing Development
Bronx Clergy Roundtable
Brooklyn Together
Clergy United for Community Empowerment
Coalition for Asian American Children and Families
Coalition of Behavioral Health Agencies
Council of Family and Child Caring Agencies
Day Care Council
Faith in New York
Hispanic Federation
Homeless Services United
Human Services Council
Interagency Council of Developmental Disabilities Agencies
Live On New York
Manhattan Together
Micah Clergy Roundtable
Neighborhood Family Services Coalition
New York AIDS Coalition
New York City Employment Training Coalition
New York Immigration Coalition
Nonprofit New York
Supportive Housing Network
United Neighborhood Houses
In which areas can FPWA offer support? (
check all that apply by holding 'left ctrl' on your computer
)
Please select...
Strengthen organizational capacity through grants, management consultation, professional development, employee assistance, and much more
Access support for your communities–through scholarships and stipends, financial support, and donations
Connect with an extended network of policymakers, legislators, and other human service and faith-based organizations
Effectively advocate for policies and programs aimed at strengthening human services agencies and increasing economic security
Executive Director (or Equivalent) Contact
First Name
Last Name
Title
E-mail
Key Programmatic Contact
First Name
Last Name
Title
E-mail
Key Policy & Advocacy Contact
First Name
Last Name
Title
E-mail
Key Administrative/Finance Contact
First Name
Last Name
Title
E-mail