Please fill out this online application form if you are
interested in becoming a First Work Member.

Agency Name:

Program Name: (If applicable)

Address:

Suite/Floor:

City:

Postal Code:

Courier Address: (If different)

Telephone:

Fax Number:

Organization E-mail address:

Organization Website:

Name of Contact Person:

Telephone:

Personal E-mail address:

Agency Information:

1. Organizational status: Incorporated, Non-profitRegistered charity

Charitable Number:

2. Services:
Please provide a summary description of the youth employment programs and services that you provide, including your catchment area:

3. Duration:
How long has your agency been providing youth employment services?
Since:

4. Areas of Interest: Research and evaluationEffective youth practiceNetwork expansionProfessional DevelopmentCollective Impact and Purchasing Opportunities

5. Membership Type:

Strategic Membership: $1000.00 for agencies with an annual Operating Budget* greater than $500,000$750.00 for agencies with an annual Operating Budget* greater than $200,000, but less than $500,000$500.00 for agencies with an annual Operating Budget* less than or equal to $200,000

Stakeholder Membership: $500.00 for agencies with an annual Operating Budget* greater than $500,000$375.00 for agencies with an annual Operating Budget* greater than $200,000, but less than $500,000$250.00 for agencies with an annual Operating Budget* less than or equal to $200,000

Attachments:
Please send the following information along with this application:

Copy of incorporation papers/other legal documentation to confirm organizational status and duration

Latest annual report

A brochure or description of current programs and services