Project Partnership Service Listing Request

Disclaimer: Please note that completing our online form does not guarantee the delivery of no-charge grooming services. Our service delivery to the community is based on the availability of funding and manpower. If approved your agency will be placed on a list that we will regularly supply to barbershops and beauty salons that provide grooming support services to target populations with barriers to regular hair care. 

Note: DO NOT ENTER COMMAS WITHIN ANY NUMERICAL TEXT BOXES ON YOUR ANSWERS. ALL QUESTIONS MUST BE ANSWERED. YOU CANNOT SAVE AND RETURN TO THIS APPLICATION AT A LATER TIME.


Note: We will email you within 5 business days concerning your listing approval.

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* 1. Today's Date

Date

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* 2. Person filling out this survey

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* 3. Name and address of your Organization

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* 4. What year was your organization founded (an estimate is acceptable)?

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* 5. Estimated number of staff at your organization

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* 6. Estimated number of active volunteers

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* 7. Description of your organization (Check all that apply)

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* 8. Select each geographic area(s) served by your organization (check all that apply)

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* 9. Estimate the average number of non-duplicated individuals served by your organization on an annual basis

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* 10. Estimate the number of clients you serve annually who live below US poverty guidelines ($12,880 annually). Please include children

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* 11. Estimate the average total number of clients served below the age of 18 annually

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* 12. Estimate the average total number of clients served above the age of 18 annually

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* 13. Estimate the total number of male clients served annually

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* 14. Estimate the total number of female clients served annually

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* 15. Estimate the percentages of ethnic groups served by your organization annually in the boxes below (do not place the % symbol in the text box)

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* 16. Of the total non-duplicated clients served annually, estimate the amount that you believe lack access to regular grooming services and products

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* 17. Select the gender(s) you serve who are in need of regular grooming services

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* 18. Select the age group(s) who you serve that are in need of grooming services and products (select all that apply)

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* 19. Rank in order the common grooming/hygiene problems that you observe with "1" being the most observed and "5" being least observed (all items must be ranked)

  1 2 3 4 5
Unkempt/unstyled hair
Uncut hair
Unclean hair
Body odor
Dental issues

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* 20. Rank in order the services needed by the clients of your organization with "1" being the service most needed to "6" being the service least needed. (all items must be ranked)

  1 2 3 4 5 6
Haircuting Services
Hairstyling Services
Grooming Products (gels, sprays, shampoos, conditioner, etc.)
Grooming Equipment (blow dryers, curling irons, brushes, razors, combs, etcs.)
Grooming Training Session for Clients and/or Staff
Chemical Services (permenent waves, relaxers, color treatment, etc.)

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* 21. Rank in order your clients barrier(s) to regular grooming services and products with "1" being the greatest barrier and "5" the least barrier. All items must be ranked (including "none")

  1 2 3 4 5
Unable to afford regular grooming services
Lacks sufficient transportation to attend barber and/or beauty salon
Unaware of the locations of barber and beauty salons in the community
Lack of physical mobility and/or health issuses
None

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* 22. As it relates to their income, rank where you believe your clients usually prioritize the cost of regular grooming services with "1" being highest priority and "8" being lowest priority (all items must be ranked)

  1 2 3 4 5 6 7 8
Housing
Childcare
Transportation
Grooming Services
Food
Healthcare
Clothing
Education

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* 23. Rank in order what are YOUR ORGANIZATION'S barriers to providing grooming services to your clients with "1" being the greatest barrier and "6" being the least greatest barrier. All items must be ranked (including "no barriers")

  1 2 3 4 5 6
No barriers
Lack of a volunteer program that will enlist a professional barber and/or hairstylist
Lack of available funds to hire a professional barber and/or stylist
Lack of technical assistance on how we can operate our own barber/beauty area in our facility
Lack of funding to operate a full-service barber/beauty area in our facility
Lack of available personnel to oversee a barber/beauty area in our facility

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* 24. Does your organization allocate money in the budget specifically to provide grooming services to your clients?

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* 25. What is the current range of your organization's annual budget

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* 26. Does your organization possess the ability to transport your clients to a designated location to received grooming services?

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* 27. Does your organization have a volunteer program and/or volunteer coordinator?

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* 28. As a condition of receiving grooming services and/or products from the RBCF, your clients must fill out a sign-in form that will measure the project's impact on their current condition. Do you agree to allow this sign-in process to take place?

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* 29. Place any additional comments here.

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