Black Caregiver Directory application

Sawubona Africentric Circle of Support

1.Please provide the full legal name of your business:(Required.)
2.Please enter business address:(Required.)
3.Please enter your website/social media handles:(Required.)
4.Please provide a brief description of your business/organization and the services/products you offer:(Required.)
5.How does your business specifically support Black caregivers of children or adults with disabilities ? (e.g., special programs, discounts, resources, partnerships):(Required.)
6.Please describe any partnerships or collaborations with organizations that support Black caregivers of children or adults with disabilities:(Required.)
7.What inspired your business to support Black caregivers of people living with disabilities?(Required.)
8.Please describe your business’ commitment to, diversity, equity, and inclusion of people with disabilities:(Required.)
9.Please provide any relevant statistics or examples that demonstrate your commitment to supporting Black caregivers and the broader Black community:(Required.)
10.Does your business/organization meet the criteria as a B3 organization (Black-led, Black-serving, Black-focused)?(Required.)