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