PARTNERSHIP WAITING LIST

Organization name:

Is the organization located in Baltimore City?

Yes

The organization is a?

501(c)3

Religious organization

Government organization (including schools)

Organization Tax ID Number?

What year was the organization founded?

Organization's mission statement

Organization's physical address?

Organization's website?

Organization phone number

Name of main point of contact

Email of main point of contact

Phone number of main point of contact

How many UNDUPLICATED children ages 0-5 does the organization serve each year?

How many children 0-5 does the organization server each month?

Does the organization have multiple sites that would be served by ShareBaby?

Yes

If yes, how many sites does the organization have?

Do you understand that ShareBaby cannot guarantee how long your agency will be on the waiting list?

Yes

1792 Union Ave.

Baltimore, MD 21211

EIN-47-2325575