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The People's Network Organization Member Intake Form

Organization name

*

Organization website

*

Organization description

*

Organization's mission or primary purpose

*

Organization type

*

Primary contact's name

*

Position/role in organization

*

Email address

*

Is this person authorized to vote/communicate with TPN on the organization's behalf?

*

A

Yes

B

No

Back up contact person

*

Back up email

*

Back up role

*

Is this back up authorized to vote/communicate with TPN on the organization's behalf?

*

A

Yes

B

No

What programs, services, activities does your organization provide?

*

What challenges are your organization facing

*

What issues are your community facing?

*

What resources would be most useful to your organization?

*

What skills, experience, services, knowledge, or resources could your organization potentially make available to the TPN community?

*

Would your organization be interested in offering resources or services to TPN members?

*

A

Yes

B

No

Are there projects or issues where you think TPN and your organization could work together?

*

Are there any other organizations or community groups that you think TPN should connect with?

*

Would your organization be willing participate in collective action, including but not limited to, boycotts, slow downs, strikes, or protests?

*

A

Yes

B

No

Would you like your organization to be listed in TPN's public community resource directory?

*

A

Yes

B

No

Name of person filling out the form

*

Role in the organization

*

Date

*