Community Partners Application - Southeast and Southwest Area Plans

**Deadline extended to November 1st at 4:00pm**

Thank you for your interest in becoming a Community Partner! Please fill out this form to express your interest and explain how you are qualified to conduct this outreach.

More information about the Southeast Area Plan: https://www.cityofmadison.com/southeastplan
More information about the Southwest Area Plan: https://www.cityofmadison.com/southwestplan

Questions? Email southwestareaplan@cityofmadison.com or call 608-243-0470.

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* 1. Applicant Name

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* 2. Is the applicant an individual or organization/group?

Individual

Organization/ Group

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* 3. Email address:

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* 4. Phone number

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* 5. Mailing Address

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* 6. Will you be partnering with any other organizations? (optional)

Yes

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* 7. Name of other organization(s) involved and primary contact person (optional)

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* 8. Which Area will you conduct outreach in?

Southeast Area

Southwest Area

Both the Southeast and Southwest Areas

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* 9. How much funding are you requesting to complete this work? (between $3,000 - $5,000)

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* 10. Please identify which underrepresented stakeholder groups you or your organization has demonstrated relationships with and will conduct outreach to (check all that apply):

African American/Black residents

Asian/Pacific Islander residents

Hispanic/Latinx residents

Hmong residents

People with disabilities

People for which English is a second language

Renters living in the Southeast and/or Southwest area

Other group (please specify)

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* 11. If you selected more than one group for question 10, is there a group you anticipate being most effective at reaching?

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* 12. How are you or your organization particularly qualified to engage the group(s) you selected in question 10? Please provide some examples of your past work. (350 words or less)

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* 13. Describe the outreach methods you expect to use to connect with stakeholders. (200 words or less)

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* 14. How will the funding be used and/or distributed? This can include your own hours worked. (100 words or less)

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* 15. If the applicant is an organization, do you plan to have existing staff conduct the outreach or would you hire one or more people from the community to conduct the outreach? Please explain. (100 words or less)

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* 16. How many hours do you anticipate working per week?

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* 17. Do you have transportation to perform this job? Please note: Car ownership is not required.

Yes

Other (please explain)

Community Partners Application - Southeast and Southwest Area Plans

Question Title

* 1. Applicant Name

Question Title

* 2. Is the applicant an individual or organization/group?

Question Title

* 3. Email address:

Question Title

* 4. Phone number

Question Title

* 5. Mailing Address

Question Title

* 6. Will you be partnering with any other organizations? (optional)

Question Title

* 7. Name of other organization(s) involved and primary contact person (optional)

Question Title

* 8. Which Area will you conduct outreach in?

Question Title

* 9. How much funding are you requesting to complete this work? (between $3,000 - $5,000)

Question Title

* 10. Please identify which underrepresented stakeholder groups you or your organization has demonstrated relationships with and will conduct outreach to (check all that apply):

Question Title

* 11. If you selected more than one group for question 10, is there a group you anticipate being most effective at reaching?

Question Title

* 12. How are you or your organization particularly qualified to engage the group(s) you selected in question 10? Please provide some examples of your past work. (350 words or less)

Question Title

* 13. Describe the outreach methods you expect to use to connect with stakeholders. (200 words or less)

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* 14. How will the funding be used and/or distributed? This can include your own hours worked. (100 words or less)

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* 15. If the applicant is an organization, do you plan to have existing staff conduct the outreach or would you hire one or more people from the community to conduct the outreach? Please explain. (100 words or less)

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* 16. How many hours do you anticipate working per week?

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* 17. Do you have transportation to perform this job? Please note: Car ownership is not required.

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* 18. How did you hear about this opportunity?