Community Partner Application

Region * Select Region ITHands test city BTGHT Test City North Texas ITHands test city 1 New England Arizona Test City one NW Oregon JUST Conference 22 Kansas City Metro Test New Region1

Organization name *

Address *

Website ( Please include http or https )*

Date founded *

501c3 ? *

EIN/Tax ID# *

President/Board Chair Name *

Email *

Phone *

Your name *

Title *

Your Email *

Phone *

Supervisor Name *

Supervisor Email *

Supervisor's title *

Supervisor's Phone *

Organization Mission/Vision *

Services or resources provided to sexually exploited or trafficked victims

Professional or special training that may be valuable to the Bridging the Gap Community

Current or previous community events, partnerships, or collaborative projects

Additional information helpful to the Bridging the Gap community

Organization name *

Contact Name *

Email *

Phone *

Organization Name *

Contact name *

Email *