FULL MEMBERSHIP APPLICATION | Michigan Federation for Children and Families

Full Membership is open to private nonprofit child and family service agencies, statewide or regional agencies responsible for coordination of services of private nonprofit child and family service agencies and agencies operated as subdivisions or branches of a national, regional, or statewide administered child and family service agency in Michigan.

Full member applicant assessment and approval procedure
The following process will be used to review and assess applications for Federation full membership.
1. Application and requested attachments are received.
2. Applicable state licensing reports are requested.
3. A meeting is scheduled with the applicant to become familiar with the agency and its leadership; to discuss Federation purposes, goals, and benefits of member participation; and to explore any areas where there may be questions about eligibility for membership.
4. Federation Executive Committee reviews the application and supportive materials and makes a recommendation to the Federation Board.
5. Board votes on the application.
6. Applicant is notified of Board vote.
7. If application is approved, membership commences upon receipt of initial dues payment.

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TO BE COMPLETED BY APPLICANT:

Complete, formal name of organization:

Street address:

City & State:

Zip code:

County of main office location:

Mailing address (if different): Street/PO box:

Agency web address:

Agency main phone:

Chief executive's name:

Chief executive's title:

Chief executive's email:

Executive's cell phone:

Number of years in position:

Number of year with the agency:

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Our agency serves the following Michigan counties:

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with branch offices in the following cities (include complete address & programs/services at the location):
You may attached a typed list below if needed.

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List of agency branch offices (include complete address & programs/services at the location):

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Our agency serves the following other states and/or countries:

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How did you learn about the Federation?

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Please check below if your agency programs are accredited by a national standards-setting body:

Council on Accreditation

Joint Commission

Commission on Accreditation of Rehabilitation Facilities

Other (please specify)

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Programs/services your agency provides; check all that apply:

Adoption

Behavioral Health

Family Preservation

Foster Care

Independent Living Plus

Juvenile Justice

Qualified Residential Treatment Program

Treatment Foster Care

Unaccompanied Refugee Minors

Adventure-based program

Community-based services

Corrections program—adults

Day care for children

Day treatment

Education

Emergency shelter

Employee assistance

Employment assistance

Family counseling

Refugee resettlement service

Respite care

Senior services

Substance use services

Volunteer programs

Other:

On behalf of all programs and services provided by your agency in Michigan, please provide current information as follows:

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HUMAN IMPACT

# of children served annually

# of adults served annually

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ECONOMIC IMPACT

Total # of employees (full- and part-time together)

Total salaries cost annually

Total fringe benefits cost annually (do not include payroll taxes)

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COMMUNITY INVESTMENT

Private donation dollars raised annually

Value of equipment, land, buildings

# of individuals on your agency board

# volunteers engaged annually

# volunteer hours donated annually

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Federation Full Member Annual Dues Calculation:
Understanding that Federation membership, once approved by the Federation Board of Directors, commences upon receipt of a full member's initial dues payment based on an audit of the agency's most recently-completed fiscal year, I calculate our annual dues as follows:

Total agency expenditures [to include unrestricted operating expenditures, restricted fund(s) expenditures and depreciation expense; and to exclude capital asset acquisition expenditures] last-completed fiscal year: (A)

Full member dues formula: x .00326 (B)

Multiply figure A by B: (C)

Annual member dues amount:*Apply minimum or maximum as per chart above. (D)

Federation Legal Trust Fund Annual Assessment: Calculate 5%** of figure D: (E)

*Annual dues will be pro-rated if an agency joins after October 1.
**This assessment percentage is established by the LTF Board of Trustees and may change from year to year.

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Applicant's typed signature indicates applicant organization subscribes to the Federation's purposes as defined in the Federation's Articles of Incorporation, Bylaws, Membership Standards, and Board Policies:

FULL MEMBERSHIP APPLICATION | Michigan Federation for Children and Families

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* TO BE COMPLETED BY APPLICANT:

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* Our agency serves the following Michigan counties:

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* with branch offices in the following cities (include complete address & programs/services at the location):You may attached a typed list below if needed.

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* List of agency branch offices (include complete address & programs/services at the location):

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* Our agency serves the following other states and/or countries:

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* How did you learn about the Federation?

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* Please check below if your agency programs are accredited by a national standards-setting body:

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* Programs/services your agency provides; check all that apply:

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* HUMAN IMPACT

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* ECONOMIC IMPACT

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* COMMUNITY INVESTMENT

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* Applicant's typed signature indicates applicant organization subscribes to the Federation's purposes as defined in the Federation's Articles of Incorporation, Bylaws, Membership Standards, and Board Policies:

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* Most recent audited financial statement: (Required.)

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* Agency organizational chart

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* Most recent annual report of agency services and programs

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* Current list of agency board members

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* If licensed, verification of valid current license

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* If accredited, most recent certificate of accreditation

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* Written statement of agency's mission

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* Descriptive brochures about agency programs.

TO BE COMPLETED BY APPLICANT:

Our agency serves the following Michigan counties:

with branch offices in the following cities (include complete address & programs/services at the location):
You may attached a typed list below if needed.

List of agency branch offices (include complete address & programs/services at the location):

Our agency serves the following other states and/or countries:

How did you learn about the Federation?

Please check below if your agency programs are accredited by a national standards-setting body:

Programs/services your agency provides; check all that apply:

HUMAN IMPACT

ECONOMIC IMPACT

COMMUNITY INVESTMENT

Applicant's typed signature indicates applicant organization subscribes to the Federation's purposes as defined in the Federation's Articles of Incorporation, Bylaws, Membership Standards, and Board Policies:

Most recent audited financial statement: (Required.)

Agency organizational chart

Most recent annual report of agency services and programs

Current list of agency board members

If licensed, verification of valid current license

If accredited, most recent certificate of accreditation

Written statement of agency's mission

Descriptive brochures about agency programs.