MEMBERSHIP APPLICATION

Please complete and submit this online application form. Your organization will be billed after we receive copies of the additional required information listed below. If you have any questions, please feel free to contact Justyna Kiehl at jkiehl@alliance1.org or 800-221-3726 ext. 3658; or fax (414) 359-1074.
Organization name
Is your organization a state association?   Yes     No
Desired Alliance membership date
(list month and year 00/00)
Mailing address
City    State    Zip
 
Phone (with area code)
Fax (with area code)
Executive name and formal title
Contact e-mail address
Head of board and formal title
Business mailing address for head of board (if different from organization)
 
City    State    Zip

Year organization founded
Number of staff (all sites)
Number of sites
Annual budget
Personnel budget

Mission

Geographic area served (main metro areas or counties)

Programs and services offered (separate by commas -  i.e. adoption, elder care, etc.)

Is your organization a member of any other national associations?   Yes     No

If yes, please name the association(s) and the amount of annual dues:

Name     Annual dues

Name     Annual dues

Name     Annual dues

PLEASE SEND THE FOLLOWING ADDITIONAL ITEMS TO THE ALLIANCE (address below) AS SOON AS POSSIBLE: (be sure each item is identified with your full organization name and address)

* One copy of last year's financial audit to be used in formal calculation of dues

* Your organization's annual report

* [OPTIONAL] A copy (CD preferred) of your agency's most current accreditation self-study from the Council on Accreditation (COA). This will be housed in the Severson National Information Center and shared with other Alliance members, as appropriate. The Severson Center will reimburse your postage for this item. Please check the following to allow the Severson Center to share your COA self-study materials with the Alliance membership.

The Alliance for Children and Families has permission to add documents such as sample bylaws, job descriptions, personnel policies, administration and management policies, and other supporting, non-confidential documents from our COA Self-Study to the Severson National Information Center collection to share with other Alliance members.

* Click here to print and sign a separate agreement form to send along with the above items. You must do this before you click "submit" below.

Mailing address for additional items:

  • Alliance for Children and Families
    ATTN: Director of Marketing
    11700 W. Lake Park Drive
    Milwaukee, WI  53224

Thank you for your interest in the Alliance for Children and Families.  We look forward to welcoming you into the Alliance Member Network!  If you have any questions, please contact Justyna Kiehl at jkiehl@alliance1.org or 800-221-3726 ext. 3658; or fax (414) 359-1074.