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YWCA Model Program Submission Application

Welcome to the YWCA USA Model Program Submission Application .

Thank you for your leadership.  

PLEASE NOTE: The survey should be completed in one sitting and must be completed online through the Survey Monkey website. After the last question (33), at the bottom of the second page, click DONE to submit the survey.  An * indicates that the item requires a response. 
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1.YWCA Local Association Name(Required.)
2.Select Your YWCA USA Geographic Network(Required.)
Program History & Overview
3.Program Name(Required.)
4.If there is a website for this program, provide the URL here (if there is no website, skip this question).
5.Program Target Audience: Age (Check all that apply)(Required.)
6.Program Target Audience: Race and Ethnicity (Check all that apply)(Required.)
7.Program Target Audience: Gender & Sex (Check all that apply)(Required.)
8.Program Target Audience: Socio-economic Status (Check all that apply)(Required.)
9.Program Target Audience: Miscellaneous.  (Check all that apply)(Required.)
10.What problem or issue is this program meant to address?(Required.)
11.Was this program created by your local association?(Required.)
12.Was this program adapted specifically for your association from an existing program?(Required.)
13.Is this program considered proprietary to:(Required.)
14.Is there a fee or license associated with this program?(Required.)
15.Is this fee or license one-time or annual?(Required.)