Pathways to Excellence Enrollment Form Survey

Complete this form to start the Pathways to Excellence Enrollment process. You will need:

Basic agency information including service area, number of FTEs, and annual budget;
Agency strategic plan;
Board resolution supporting the pursuit of Excellence (Silver, Gold, and Platinum tiers only); and
Most recent 990 form (Silver, Gold, and Platinum tiers only)

The Partnership will use the information provided to start your enrollment process and generate an invoice for appropriate fees. Please note that enrollment is not complete until payment is received.

1.Agency Name(Required.)

2.Agency Address(Required.)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

3.Executive Director Name(Required.)

4.Primary Contact Information(Required.)

Name

Email Address

Phone Number

6.Total Agency Revenue(Required.)

Amount of total Agency Revenue (from line 12 of most recent IRS Form 990)
If your agency is a public CAA, please provide your agency budget

IRS 990 Form Year
If your agency is a public CAA, please provide the agency budget year

7.Number of full-time equivalent staff (FTEs)

8.Pathways Enrollment Level(Required.)

Bronze

Silver

Gold

Platinum

9.Strategic Plan

Please include your current Strategic Plan

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10.For the Silver, Gold and Platinum tiers, please attach your Board Resolution supporting the agency pursuit of Excellence.

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11.IRS Form 990

For those enrolling in Silver, Gold, and Platinum levels, please include your most recent IRS Form 990. The 990 is used to verify tier pricing. Public CAAs should upload official documentation of budget size to verify tier pricing.

No file chosen

12.Payment Options - Please select your preferred billing and payment method below.(Required.)

Receive an invoice by email sent to the designated agency MemberSuite account billing contact for an online credit card payment to be made by an authorized agency staff member.

Receive an invoice by email sent to the agency primary contact for an online credit card payment to be made.

Receive an invoice by an email to the primary contact for payment by check through the mail.

Congratulations on starting your excellence journey! We will follow up with you to confirm receipt of your materials soon.

If you have any questions in the meantime, please contact us:

Excellence@CommunityActionPartnership.com

Please click "submit" to complete this form.

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