Responses in this section will NOT appear on any public-facing materials. We will contact you at the email address indicated if we have any questions about this program submission.
First name
* must provide value
Last name
* must provide value
Your institutional email
* must provide value
(username@vcu.edu -OR- username@vcuhealth.org)
Your school/unit
* must provide value
Latitude and longitude of submitter's location
Update reset
This section asks questions about the university-community partnership.
Partnerships are between a VCU/VCUHealth employee or unit and an external organization. External organizations, such as community partners, can include non-profits, businesses, government agencies, schools, art galleries, etc.
Many activities can occur as part of a university-community partnership, including:
• Teaching/Service-Learning
• Internships/Practica
• Research/Creative
• Service/Outreach
• Health-related
The document attached below defines activity and provides examples.
Responses in this section will be made available to the public, unless specifically noted.
Title of Partnership
If no formal title exists for this partnership, provide a brief descriptive title.
* must provide value
Please provide a very brief (1-2 sentences) overview of the partnership.
Example:
BeautifulRVA: This partnership between VCU School of Arts, the Wilder School, Groundwork RVA, Lewis Ginter Botanical Garden, City of Richmond Office of Sustainability, and TMI Consulting, Inc, aims to coordinate a community-based beautification initiative for Richmond through outreach and service.
* must provide value
Activities definition are found in the attached.
Select the type of activity that describes this partnership.
* must provide value
Select all that apply.
Indicate one school/unit directly involved with the partnership (i.e., oversees planning, managing, or implementing of activities).
You may list up to five VCU Units.
* must provide value
Academic Affairs, Office of the Provost and Vice President for Allied Health, School of Arts, School of the Business, School of Centers and Institutes Dentistry, School of Department of Assurance Services Development and Alumni Relations, Office of Education, School of Engineering, School of Finance and Administration, Office of the Senior Vice President General Counsel, Office of Government and Public Affairs, Wilder School Health Sciences, Office of the Vice President for Health System, VCU Honors College Humanities and Sciences, College of Intercollegiate Athletics, Department of Life Sciences, VCU Medicine, School of Nursing, School of Pharmacy, School of President, Office of the Research, Office of Social Work, School of Student Affairs, Division of University College University Relations, Division of World Studies, School of Vice President of Health Science, Office Of Massey Cancer Center Other
Choose one. More questions on units involved follow this question.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Does this partnership directly involve additional school(s) or unit(s)?
* must provide value
Yes No
Indicate the 2nd school/unit directly involved with the partnership's planning, managing, or implementing of activities.
* must provide value
Academic Affairs, Office of the Provost and Vice President for Allied Health, School of Arts, School of the Business, School of Centers and Institutes Dentistry, School of Department of Assurance Services Development and Alumni Relations, Office of Education, School of Engineering, School of Finance and Administration, Office of the Senior Vice President General Counsel, Office of Government and Public Affairs, Wilder School Health Sciences, Office of the Vice President for Health System, VCU Honors College Humanities and Sciences, College of Intercollegiate Athletics, Department of Life Sciences, VCU Medicine, School of Nursing, School of Pharmacy, School of President, Office of the Research, Office of Social Work, School of Student Affairs, Division of University College University Relations, Division of Vice President of Health Sciences, Office of Massey Cancer Center Other
Choose one. More questions on units involved follow this question.
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' subunit.
* must provide value
Does this partnership directly involve additional school(s) or unit(s)?
* must provide value
Yes No
Indicate the 3rd school/unit directly involved with the partnership's planning, managing, or implementing of activities.
* must provide value
Academic Affairs, Office of the Provost and Vice President for Allied Health, School of Arts, School of the Business, School of Centers and Institutes Dentistry, School of Department of Assurance Services Development and Alumni Relations, Office of Education, School of Engineering, School of Finance and Administration, Office of the Senior Vice President General Counsel, Office of Government and Public Affairs, Wilder School Health Sciences, Office of the Vice President for Health System, VCU Honors College Humanities and Sciences, College of Intercollegiate Athletics, Department of Life Sciences, VCU Medicine, School of Nursing, School of Pharmacy, School of President, Office of the Research, Office of Social Work, School of Student Affairs, Division of University College University Relations, Division of Vice President of Health Sciences, Office of Massey Cancer Center Other
Choose one. More questions on units involved follow this question.
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Does this partnership directly involve additional school(s) or unit(s)?
* must provide value
Yes No
Indicate the 4th school/unit directly involved with the partnership's planning, managing, or implementing of activities.
* must provide value
Academic Affairs, Office of the Provost and Vice President for Allied Health, School of Arts, School of the Business, School of Centers and Institutes Dentistry, School of Department of Assurance Services Development and Alumni Relations, Office of Education, School of Engineering, School of Finance and Administration, Office of the Senior Vice President General Counsel, Office of Government and Public Affairs, Wilder School Health Sciences, Office of the Vice President for Health System, VCU Honors College Humanities and Sciences, College of Intercollegiate Athletics, Department of Life Sciences, VCU Medicine, School of Nursing, School of Pharmacy, School of President, Office of the Research, Office of Social Work, School of Student Affairs, Division of University College University Relations, Division of Vice President of Health Sciences, Office of Massey Cancer Center Other
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Does this partnership directly involve additional school(s) or unit(s)?
* must provide value
Yes No
Indicate the 5th school/unit directly involved with the partnership's planning, managing, or implementing of activities.
* must provide value
Academic Affairs, Office of the Provost and Vice President for Allied Health, School of Arts, School of the Business, School of Centers and Institutes Dentistry, School of Department of Assurance Services Development and Alumni Relations, Office of Education, School of Engineering, School of Finance and Administration, Office of the Senior Vice President General Counsel, Office of Government and Public Affairs, Wilder School Health Sciences, Office of the Vice President for Health System, VCU Honors College Humanities and Sciences, College of Intercollegiate Athletics, Department of Life Sciences, VCU Medicine, School of Nursing, School of Pharmacy, School of President, Office of the Research, Office of Social Work, School of Student Affairs, Division of University College University Relations, Division of Vice President of Health Sciences, Office of Massey Cancer Center Other
If you have more than five VCU units to report for ______ , please list additional units. These are units that are directly involved.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Select the department/sub-unit.
* must provide value
Please indicate 'other' unit.
* must provide value
Partnership work often serves various geographic areas.
Please select all applicable geographic area(s) that this partnership serves.
Metro Richmond boundaries parallel DataShare Metro Richmond. See www.datashare.org for Metro Richmond boundaries.
Areas outside of Metro Richmond parallel the Capital Region Collaborative. See http://www.capitalregioncollaborative.com/index.php/the-region/ for outside of the metro area.
* must provide value
Select all that apply.
Partnerships often focus on addressing a variety of issues.
Please select all applicable focus areas for this partnership.
* must provide value
Select all that apply.
Please indicate the 'other' focus area.
Full name of the primary faculty/staff directly involved with ______ .
* must provide value
This name will be listed as the primary contact for public-facing materials.
Primary faculty/staff's institutional email
(VCU email only)
* must provide value
(username@vcu.edu -or- username@vcuhealth.org)
Faculty's online bio page
Sometimes programs have generic email addresses not tied to named individuals. Would you like to use a program-specific email address in lieu of an email address of a named individual for public-facing materials?
* must provide value
Yes No
______ will be included as the primary contact for ______ on all public-facing materials.
Does this partnership have additional faculty/staff to include as contacts?
* must provide value
Yes No
Additional Faculty Staff name 2
Additional faculty/staff institutional email
(VCU email only)
(username@vcu.edu -or- username@vcuhealth.org)
Does this partnership have additional faculty/staff? You may list up to three additional faculty/staff.
* must provide value
Yes No
Additional Faculty Staff name 3
Additional faculty/staff institutional email 3
(username@vcu.edu -or- username@vcuhealth.org)
Does this partnership have additional faculty/staff? You may list up to two additional faculty/staff.
* must provide value
Yes No
Additional Faculty Staff name 4
Additional faculty/staff institutional email 4
(username@vcu.edu -or- username@vcuhealth.org)
Does this partnership have additional faculty/staff? You may list up to one additional faculty/staff.
* must provide value
Yes No
Additional Faculty Staff name 5
Additional faculty/staff institutional email 5
(username@vcu.edu -or- username@vcuhealth.org)
Community Partner Organization's name
Select from below or choose 'Other' if not on dropdown list.
* must provide value
10,000 Villages A Grace Place Boaz and Ruth Bradley Free Clinic Camp Diva Capital One Boys and Girls Club CARITAS Carver Promise CBS 6 Center for High Blood Pressure Central VA Waste Management Authority Central Virginia Asthma Coalition Charlottesville Free Clinic Chesapeake Care Free Clinic Chester House- Chesterfield County Community Services Board Chesterfield County Public Schools: Cosby High School Chesterfield County Public Schools: Hopkins Elementary School Chesterfield Health District Chimborazo Elementary School Circle Center Adult Day Services Clover Hill High School Communities In Schools of Richmond Community Dental Clinic Community Kitchen Garden, Lewis Ginter Botanical Garden Continental Societies of Richmond Craniofacial Clinic Cross Over Ministries Clinic CrossOver Ministry Dental Clinic Daily Planet Dental Medicine District One Probation and Parole Office East End Cemetery F.I.R.S.T. Contractors Family Lifeline Fan Free Clinic Federal Correctional Complex Petersburg FeedMore Free Clinic of Central Virginia Free Clinic of Central Virginia- Lynchburg Friends Association for Children Friends of James River Park Gateway Homes, Inc. Goochland Free Clinic Goochland Free Clinic and Family Services Hands Up Ministry Hanover County School Health Services Hanover Interfaith Free Clinics at Mechanicsville Christian Center Hanover Safe Place Health and Wellness Initiative Higher Achievement Highland Spring Support Project Highland Support Project Home Again Hopewell High School James River Park System Lobs & Lessons Lucy Corr Village Mary and Frances Youth Center Master Gardeners (Chesterfield County chapter) Master Naturalists (Pocahontas Chapter) Maymont Park Maymont Park Foundation MCV Child Care Center Metro Cash Micah Initiative Minority Health Consortium Mosby Tenant Association Neighbor-To-Neighbor Initiative Neighborhood Resource Center Northern Neck Free Health Clinic Northminster Church Offender Aid and Restoration Open Door Resource Center Park Place Dental Clinic Park Place Health and Dental Clinic Partnership for Families Northside PATHS Community Dental Center Paul Manning and the City of Richmond Mayor's Office Peter Paul Development Center Pfizer Consumer Healthcare, Inc., Native Bee Garden Powhatan High School Prince George High School ReStore Habitat for Humanity Richmond ARC Richmond City Health District Richmond City Jail Richmond City Public Schools: Binford Middle School Richmond City Public Schools: John Marshall High School Richmond City Public Schools: Richmond Community High School Richmond City Sheriff's Office Richmond Memorial Foundation Richmond Peace Education Center Richmond Promise Neighborhood Richmond Public Schools: Binford Middle School Richmond Redvelopment and Housing Authority (RRHA) Richmond Sister Cities Commission ROOTS: Reinventing Ourselves Outside the System RRHA S.A.V.E.S. & M.A.V. (student organizations at VCU through the VCU Sexual Assault and Domestic Violence Services) Sacred Heart Center Salvation Army Boys and Girls Club School of Nursing Shalom Farms University of KwaZulu Natal South Africa Southwest Virginia Regional Dental Center Special Olympics Virginia Sportable St. Andrew's Schools Stuff Redux The Daily Planet Healthcare Center-Medical Respite Facility The Healing Place The James House The Mill House The Virginia Home United Methodist Family Services US Fish and Wildlife Service VA Cooperative Extension VA Department of Conservation and Recreation VA Department of Game and Inland Fisheries Varina High School VCU Art of Nursing VCU Child Development Center VCU Wellness Resource Center Virginia Department of Emergency Management Virginia Friends of Mali VMFA Westminster Cantebury Woodville Elementary School YWCA of Greater Richmond Other, please specify below
Please enter the community partner's name
The map requires a street for community partners. Does this community partner have a physical street address (street, city, state, ZIP)?
* must provide value
Yes No
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Somoa Guam Puerto Rico U.S. Virgin Islands
We understand that sometimes the community partner(s) may not have a physical address. They have rather a physical location in which activity takes place. Please specify the physical address in which activity takes place.
Physical Street Address
* must provide value
ZIP code
For international zips, please add a few zeros before to fit into 5 or 9 numbers.
* must provide value
Country, if outside of U.S.
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (see Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe
Does this community partner have a website?
* must provide value
Yes No
Community partner website
* must provide value
Does ______ have additional community partners?
* must provide value
Yes No
Community Partner Organization's name (2)
Select from below or choose 'Other' if not on dropdown list.
* must provide value
Other, please specify below 10,000 Villages A Grace Place Boaz and Ruth Bradley Free Clinic Camp Diva Capital One Boys and Girls Club CARITAS Carver Promise CBS 6 Center for High Blood Pressure Central VA Waste Management Authority Central Virginia Asthma Coalition Charlottesville Free Clinic Chesapeake Care Free Clinic Chester House- Chesterfield County Community Services Board Chesterfield County Public Schools: Cosby High School Chesterfield County Public Schools: Hopkins Elementary School Chesterfield Health District Chimborazo Elementary School Circle Center Adult Day Services Clover Hill High School Communities In Schools of Richmond Community Dental Clinic Community Kitchen Garden, Lewis Ginter Botanical Garden Continental Societies of Richmond Craniofacial Clinic Cross Over Ministries Clinic CrossOver Ministry Dental Clinic Daily Planet Dental Medicine District One Probation and Parole Office East End Cemetery F.I.R.S.T. Contractors Family Lifeline Fan Free Clinic Federal Correctional Complex Petersburg FeedMore Free Clinic of Central Virginia Free Clinic of Central Virginia- Lynchburg Friends Association for Children Friends of James River Park Gateway Homes, Inc. Goochland Free Clinic Goochland Free Clinic and Family Services Hands Up Ministry Hanover County School Health Services Hanover Interfaith Free Clinics at Mechanicsville Christian Center Hanover Safe Place Health and Wellness Initiative Higher Achievement Highland Spring Support Project Highland Support Project Home Again Hopewell High School James River Park System Lobs & Lessons Lucy Corr Village Mary and Frances Youth Center Master Gardeners (Chesterfield County chapter) Master Naturalists (Pocahontas Chapter) Maymont Park Maymont Park Foundation MCV Child Care Center Metro Cash Micah Initiative Minority Health Consortium Mosby Tenant Association Neighbor-To-Neighbor Initiative Neighborhood Resource Center Northern Neck Free Health Clinic Northminster Church Offender Aid and Restoration Open Door Resource Center Park Place Dental Clinic Park Place Health and Dental Clinic Partnership for Families Northside PATHS Community Dental Center Paul Manning and the City of Richmond Mayor's Office Peter Paul Development Center Pfizer Consumer Healthcare, Inc., Native Bee Garden Powhatan High School Prince George High School ReStore Habitat for Humanity Richmond ARC Richmond City Health District Richmond City Jail Richmond City Public Schools: Binford Middle School Richmond City Public Schools: John Marshall High School Richmond City Public Schools: Richmond Community High School Richmond City Sheriff's Office Richmond Memorial Foundation Richmond Peace Education Center Richmond Promise Neighborhood Richmond Public Schools: Binford Middle School Richmond Redvelopment and Housing Authority (RRHA) Richmond Sister Cities Commission ROOTS: Reinventing Ourselves Outside the System RRHA S.A.V.E.S. & M.A.V. (student organizations at VCU through the VCU Sexual Assault and Domestic Violence Services) Sacred Heart Center Salvation Army Boys and Girls Club School of Nursing Shalom Farms University of KwaZulu Natal South Africa Southwest Virginia Regional Dental Center Special Olympics Virginia Sportable St. Andrew's Schools Stuff Redux The Daily Planet Healthcare Center-Medical Respite Facility The Healing Place The James House The Mill House The Virginia Home United Methodist Family Services US Fish and Wildlife Service VA Cooperative Extension VA Department of Conservation and Recreation VA Department of Game and Inland Fisheries Varina High School VCU Art of Nursing VCU Child Development Center VCU Wellness Resource Center Virginia Department of Emergency Management Virginia Friends of Mali VMFA Westminster Cantebury Woodville Elementary School YWCA of Greater Richmond
Please enter the community partner's name
The map requires a street for community partners. Does this community partner have a physical street address (street, city, state, ZIP)?
* must provide value
Yes No
We understand that sometimes the community partner(s) may not have a physical address. They have rather a physical location in which activity takes place. Please specify the physical address in which activity takes place.
Physical Street Address
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Somoa Guam Puerto Rico U.S. Virgin Islands
ZIP code
For international zips, please add a few zeros before to fit into 5 or 9 numbers.
* must provide value
Country, if outside of U.S.
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (see Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe
Does this community partner have a website?
* must provide value
Yes No
Community partner website
* must provide value
Does ______ have additional community partners?
* must provide value
Yes No
Community Partner Organization's name (3)
Select from below or choose 'Other' if not on dropdown list.
* must provide value
Other, please specify below 10,000 Villages A Grace Place Boaz and Ruth Bradley Free Clinic Camp Diva Capital One Boys and Girls Club CARITAS Carver Promise CBS 6 Center for High Blood Pressure Central VA Waste Management Authority Central Virginia Asthma Coalition Charlottesville Free Clinic Chesapeake Care Free Clinic Chester House- Chesterfield County Community Services Board Chesterfield County Public Schools: Cosby High School Chesterfield County Public Schools: Hopkins Elementary School Chesterfield Health District Chimborazo Elementary School Circle Center Adult Day Services Clover Hill High School Communities In Schools of Richmond Community Dental Clinic Community Kitchen Garden, Lewis Ginter Botanical Garden Continental Societies of Richmond Craniofacial Clinic Cross Over Ministries Clinic CrossOver Ministry Dental Clinic Daily Planet Dental Medicine District One Probation and Parole Office East End Cemetery F.I.R.S.T. Contractors Family Lifeline Fan Free Clinic Federal Correctional Complex Petersburg FeedMore Free Clinic of Central Virginia Free Clinic of Central Virginia- Lynchburg Friends Association for Children Friends of James River Park Gateway Homes, Inc. Goochland Free Clinic Goochland Free Clinic and Family Services Hands Up Ministry Hanover County School Health Services Hanover Interfaith Free Clinics at Mechanicsville Christian Center Hanover Safe Place Health and Wellness Initiative Higher Achievement Highland Spring Support Project Highland Support Project Home Again Hopewell High School James River Park System Lobs & Lessons Lucy Corr Village Mary and Frances Youth Center Master Gardeners (Chesterfield County chapter) Master Naturalists (Pocahontas Chapter) Maymont Park Maymont Park Foundation MCV Child Care Center Metro Cash Micah Initiative Minority Health Consortium Mosby Tenant Association Neighbor-To-Neighbor Initiative Neighborhood Resource Center Northern Neck Free Health Clinic Northminster Church Offender Aid and Restoration Open Door Resource Center Park Place Dental Clinic Park Place Health and Dental Clinic Partnership for Families Northside PATHS Community Dental Center Paul Manning and the City of Richmond Mayor's Office Peter Paul Development Center Pfizer Consumer Healthcare, Inc., Native Bee Garden Powhatan High School Prince George High School ReStore Habitat for Humanity Richmond ARC Richmond City Health District Richmond City Jail Richmond City Public Schools: Binford Middle School Richmond City Public Schools: John Marshall High School Richmond City Public Schools: Richmond Community High School Richmond City Sheriff's Office Richmond Memorial Foundation Richmond Peace Education Center Richmond Promise Neighborhood Richmond Public Schools: Binford Middle School Richmond Redvelopment and Housing Authority (RRHA) Richmond Sister Cities Commission ROOTS: Reinventing Ourselves Outside the System RRHA S.A.V.E.S. & M.A.V. (student organizations at VCU through the VCU Sexual Assault and Domestic Violence Services) Sacred Heart Center Salvation Army Boys and Girls Club School of Nursing Shalom Farms University of KwaZulu Natal South Africa Southwest Virginia Regional Dental Center Special Olympics Virginia Sportable St. Andrew's Schools Stuff Redux The Daily Planet Healthcare Center-Medical Respite Facility The Healing Place The James House The Mill House The Virginia Home United Methodist Family Services US Fish and Wildlife Service VA Cooperative Extension VA Department of Conservation and Recreation VA Department of Game and Inland Fisheries Varina High School VCU Art of Nursing VCU Child Development Center VCU Wellness Resource Center Virginia Department of Emergency Management Virginia Friends of Mali VMFA Westminster Cantebury Woodville Elementary School YWCA of Greater Richmond
Please enter the community partner's name
The map requires a street for community partners. Does this community partner have a physical street address (street, city, state, ZIP)?
Yes No
We understand that sometimes the community partner(s) may not have a physical address. They have rather a physical location in which activity takes place. Please specify the physical address in which activity takes place.
Physical Street Address
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Somoa Guam Puerto Rico U.S. Virgin Islands
ZIP code
For international zips, please add a few zeros before to fit into 5 or 9 numbers.
* must provide value
Country, if outside of U.S.
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (see Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe
Country, if outside of US (add additional address info here)
Does this community partner have a website?
* must provide value
Yes No
Community partner website
* must provide value
Does ______ have additional community partners?
* must provide value
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Community Partner Organization's name (4)
Select from below or choose 'Other' if not on dropdown list.
* must provide value
Other, please specify below 10,000 Villages A Grace Place Boaz and Ruth Bradley Free Clinic Camp Diva Capital One Boys and Girls Club CARITAS Carver Promise CBS 6 Center for High Blood Pressure Central VA Waste Management Authority Central Virginia Asthma Coalition Charlottesville Free Clinic Chesapeake Care Free Clinic Chester House- Chesterfield County Community Services Board Chesterfield County Public Schools: Cosby High School Chesterfield County Public Schools: Hopkins Elementary School Chesterfield Health District Chimborazo Elementary School Circle Center Adult Day Services Clover Hill High School Communities In Schools of Richmond Community Dental Clinic Community Kitchen Garden, Lewis Ginter Botanical Garden Continental Societies of Richmond Craniofacial Clinic Cross Over Ministries Clinic CrossOver Ministry Dental Clinic Daily Planet Dental Medicine District One Probation and Parole Office East End Cemetery F.I.R.S.T. Contractors Family Lifeline Fan Free Clinic Federal Correctional Complex Petersburg FeedMore Free Clinic of Central Virginia Free Clinic of Central Virginia- Lynchburg Friends Association for Children Friends of James River Park Gateway Homes, Inc. Goochland Free Clinic Goochland Free Clinic and Family Services Hands Up Ministry Hanover County School Health Services Hanover Interfaith Free Clinics at Mechanicsville Christian Center Hanover Safe Place Health and Wellness Initiative Higher Achievement Highland Spring Support Project Highland Support Project Home Again Hopewell High School James River Park System Lobs & Lessons Lucy Corr Village Mary and Frances Youth Center Master Gardeners (Chesterfield County chapter) Master Naturalists (Pocahontas Chapter) Maymont Park Maymont Park Foundation MCV Child Care Center Metro Cash Micah Initiative Minority Health Consortium Mosby Tenant Association Neighbor-To-Neighbor Initiative Neighborhood Resource Center Northern Neck Free Health Clinic Northminster Church Offender Aid and Restoration Open Door Resource Center Park Place Dental Clinic Park Place Health and Dental Clinic Partnership for Families Northside PATHS Community Dental Center Paul Manning and the City of Richmond Mayor's Office Peter Paul Development Center Pfizer Consumer Healthcare, Inc., Native Bee Garden Powhatan High School Prince George High School ReStore Habitat for Humanity Richmond ARC Richmond City Health District Richmond City Jail Richmond City Public Schools: Binford Middle School Richmond City Public Schools: John Marshall High School Richmond City Public Schools: Richmond Community High School Richmond City Sheriff's Office Richmond Memorial Foundation Richmond Peace Education Center Richmond Promise Neighborhood Richmond Public Schools: Binford Middle School Richmond Redvelopment and Housing Authority (RRHA) Richmond Sister Cities Commission ROOTS: Reinventing Ourselves Outside the System RRHA S.A.V.E.S. & M.A.V. (student organizations at VCU through the VCU Sexual Assault and Domestic Violence Services) Sacred Heart Center Salvation Army Boys and Girls Club School of Nursing Shalom Farms University of KwaZulu Natal South Africa Southwest Virginia Regional Dental Center Special Olympics Virginia Sportable St. Andrew's Schools Stuff Redux The Daily Planet Healthcare Center-Medical Respite Facility The Healing Place The James House The Mill House The Virginia Home United Methodist Family Services US Fish and Wildlife Service VA Cooperative Extension VA Department of Conservation and Recreation VA Department of Game and Inland Fisheries Varina High School VCU Art of Nursing VCU Child Development Center VCU Wellness Resource Center Virginia Department of Emergency Management Virginia Friends of Mali VMFA Westminster Cantebury Woodville Elementary School YWCA of Greater Richmond
Please enter the community partner's name
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We understand that sometimes the community partner(s) may not have a physical address. They have rather a physical location in which activity takes place. Please specify the physical address in which activity takes place.
Physical Street Address
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Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Somoa Guam Puerto Rico U.S. Virgin Islands
ZIP code
For international zips, please add a few zeros before to fit into 5 or 9 numbers.
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Country, if outside of U.S.
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (see Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe
Does this community partner have a website?
* must provide value
Yes No
Community partner website
* must provide value
Does ______ have additional community partners?
* must provide value
Yes No
Community Partner Organization's name (5)
Select from below or choose 'Other' if not on dropdown list.
* must provide value
Other, please specify below 10,000 Villages A Grace Place Boaz and Ruth Bradley Free Clinic Camp Diva Capital One Boys and Girls Club CARITAS Carver Promise CBS 6 Center for High Blood Pressure Central VA Waste Management Authority Central Virginia Asthma Coalition Charlottesville Free Clinic Chesapeake Care Free Clinic Chester House- Chesterfield County Community Services Board Chesterfield County Public Schools: Cosby High School Chesterfield County Public Schools: Hopkins Elementary School Chesterfield Health District Chimborazo Elementary School Circle Center Adult Day Services Clover Hill High School Communities In Schools of Richmond Community Dental Clinic Community Kitchen Garden, Lewis Ginter Botanical Garden Continental Societies of Richmond Craniofacial Clinic Cross Over Ministries Clinic CrossOver Ministry Dental Clinic Daily Planet Dental Medicine District One Probation and Parole Office East End Cemetery F.I.R.S.T. Contractors Family Lifeline Fan Free Clinic Federal Correctional Complex Petersburg FeedMore Free Clinic of Central Virginia Free Clinic of Central Virginia- Lynchburg Friends Association for Children Friends of James River Park Gateway Homes, Inc. Goochland Free Clinic Goochland Free Clinic and Family Services Hands Up Ministry Hanover County School Health Services Hanover Interfaith Free Clinics at Mechanicsville Christian Center Hanover Safe Place Health and Wellness Initiative Higher Achievement Highland Spring Support Project Highland Support Project Home Again Hopewell High School James River Park System Lobs & Lessons Lucy Corr Village Mary and Frances Youth Center Master Gardeners (Chesterfield County chapter) Master Naturalists (Pocahontas Chapter) Maymont Park Maymont Park Foundation MCV Child Care Center Metro Cash Micah Initiative Minority Health Consortium Mosby Tenant Association Neighbor-To-Neighbor Initiative Neighborhood Resource Center Northern Neck Free Health Clinic Northminster Church Offender Aid and Restoration Open Door Resource Center Park Place Dental Clinic Park Place Health and Dental Clinic Partnership for Families Northside PATHS Community Dental Center Paul Manning and the City of Richmond Mayor's Office Peter Paul Development Center Pfizer Consumer Healthcare, Inc., Native Bee Garden Powhatan High School Prince George High School ReStore Habitat for Humanity Richmond ARC Richmond City Health District Richmond City Jail Richmond City Public Schools: Binford Middle School Richmond City Public Schools: John Marshall High School Richmond City Public Schools: Richmond Community High School Richmond City Sheriff's Office Richmond Memorial Foundation Richmond Peace Education Center Richmond Promise Neighborhood Richmond Public Schools: Binford Middle School Richmond Redvelopment and Housing Authority (RRHA) Richmond Sister Cities Commission ROOTS: Reinventing Ourselves Outside the System RRHA S.A.V.E.S. & M.A.V. (student organizations at VCU through the VCU Sexual Assault and Domestic Violence Services) Sacred Heart Center Salvation Army Boys and Girls Club School of Nursing Shalom Farms University of KwaZulu Natal South Africa Southwest Virginia Regional Dental Center Special Olympics Virginia Sportable St. Andrew's Schools Stuff Redux The Daily Planet Healthcare Center-Medical Respite Facility The Healing Place The James House The Mill House The Virginia Home United Methodist Family Services US Fish and Wildlife Service VA Cooperative Extension VA Department of Conservation and Recreation VA Department of Game and Inland Fisheries Varina High School VCU Art of Nursing VCU Child Development Center VCU Wellness Resource Center Virginia Department of Emergency Management Virginia Friends of Mali VMFA Westminster Cantebury Woodville Elementary School YWCA of Greater Richmond
Please enter the community partner's name
The map requires a street for community partners. Does this community partner have a physical street address (street, city, state, ZIP)?
Yes No
We understand that sometimes the community partner(s) may not have a physical address. They have rather a physical location in which activity takes place. Please specify the physical address in which activity takes place.
Physical Street Address
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Somoa Guam Puerto Rico U.S. Virgin Islands
ZIP code
For international zips, please add a few zeros before to fit into 5 or 9 numbers.
* must provide value
Country, if outside of U.S.
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (see Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe
Does this community partner have a website?
* must provide value
Yes No
Community partner website
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About when did ______ partnership begin? (Month Year)
Ex: March 2012
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Is this partnership currently active?
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Yes
No
About when did this partnership end? (Month Year)
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Please provide any additional partnership information that may not have been captured in this form to help us better understand ______ .
Please attach any additional materials (i.e. photographs, brochures, logos, etc) that may be used on public-facing materials.
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