South Fork Valley Youth Outreach: Provider Survey

1.How would you like to get involved? (Check all that apply)

Teach classes

Tutor

Mentor

Lead a club

Lead outdoor activities

Make it possible for kids to come to your place of business as a field trip

Offer an internship

Plan and facilitate classes

Plan and facilitate a special event

Chaperone an event

Sponsor (i.e., help fund) local youth programming in general

Sponsor (i.e., help fund) a specific event

Help fund hall rental fees

Help fund scholarships

Serve on a volunteer planning committee

Volunteer in some capacity (please specify below)

Other (please specify)

2.Is there anything specific you would like to share with us as it relates to your answers to Question 1? For instance, can you provide details about specific ways you would like to get involved?

3.Do you or your organization already have an established program that you could bring to the local community? For example, you have a program that would be new to the local community or is already here but could expand if you had somewhere to meet? Please describe.

4.Do you or your organization have any special licenses or qualifications to work with youth or families?

5.What is your contact information?

Name

Organization (if applicable)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

6.Are there any other organizations or individuals who you suggest we talk to? What is their expertise? How do we reach them? (Please get permission from individuals before you give us a name or share their contact information.)