Ammon Empowerment Partners Inquiry Contact Information Question Title * 1. Contact Information Name Company or Organization Email Address Phone Number Partnership Interest (check all that apply) Question Title * 2. Partnership Interest (check all that apply) Empowerment Partners: Host sites for The Ammon Foundation Empowerment Workshop Series, which is a 6-module life skills training, facilitated by Certified Ammon Empowerment Coaches. Education Partners: Institutions committed to removing financial barriers in place for an individual to pursue education. Support individuals in recovery by creating matching scholarship opportunities. Advocacy Partners: Allies equally committed to raising awareness about addiction and recovery through presenting, facilitating, sponsoring and/or attending events. Partners join forces on a specific initiatives and/or events. Philanthropy Partners: Supporters that possess an altruistic desire to improve human welfare through financial giving which addresses the deadly systemic gap between addiction treatment and addiction recovery support. Partners fortify the Foundation’s mission through substantial financial gifts to ensure lasting change. Philanthropy Partners: Supporters that possess an altruistic desire to improve human welfare through financial giving which addresses the deadly systemic gap between addiction treatment and addiction recovery support. Partners fortify the Foundation’s mission through substantial financial gifts to ensure lasting change. Leadership Partners: Innovative integration of Hope, Empowerment, Advocacy and/or Philanthropy Partnerships. Other (please specify) Is your organization a 501 (c)(3)? Question Title * 3. Is your organization a 501 (c)(3)? Yes No Other (please specify) Which Workshops are you interested in? (Check all that apply.) Question Title * 4. Which Workshops are you interested in? (Check all that apply.) Self-Care Time Management 101 Going Back to School: How & Why? Study Skills Budgeting 101 Resume Writing & Interviewing Skills The Entire Series (6 modules) When are you looking to launch our Empowerment Workshop Program? Question Title * 5. When are you looking to launch our Empowerment Workshop Program? Within 30 days Within 60 days Within 90 days Other (please specify) How many clients do you wish to Empower at your facility? Question Title * 6. How many clients do you wish to Empower at your facility? 1-10 11-20 21-30 Other (please specify) What type of facility do you operate? Question Title * 7. What type of facility do you operate? Residential/SoberLiving In-patient Out-patient (IOP) Half-way house College/University/Adult Learning Community Recovery High School Other (please specify) Do you have any other comments, questions, or concerns? Question Title * 8. Do you have any other comments, questions, or concerns? Done
