Accreditation Application (payment in full up front)

Accreditation

Inform USA Accreditation is a five phase process that measures information and referral organizations against industry standards.

Non-Member Price: $9,000

Member Price: $6,000

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Please complete the requested information below to finish adding Accreditation Application (payment in full up front) to your cart.

Date form is completed:

First time Accreditation? or Reaccreditation? Is your organization applying for a first time accreditation, or a re-accreditation?

Agency/Organization Name:

Program name (for your Community Navigation program):

City and State/Province of Community Navigation program:

Your Community Navigation program's website:

Geographic area served:

Is that organization Accredited by Inform USA?

The year your organization was incorporated: If you are a government entity, you can skip this question.

The year your program was established: Note: Only applicable if different than the date the organization was incorporated.

Population of area served: Note: Please use the following website(s) to obtain this data - United States (www.census.gov) and Canada (www.statcan.gc.ca)

Why is your organizational seeking Accreditation? Please select all that apply.

Do you hold any other Accreditations? Please select all that apply.

Lead Contact (job title):

Lead Contact (email):

Lead Contact (phone number):

Alternate Contact (full name):

Alternate Contact (job title):

Alternate Contact (email):

Alternate Contact (phone number):

Database Contact (full name):

Database Contact (email):

Resource database maintained by another entity?

If externally maintained, please list name here:

Consultation Agreement: I agree, on behalf of my organization, that I have read and agree to the Accreditation Agreement and have informed my Board President (or equivalent) about this application.

Legal Status

Primary Type of Community Navigation Please indicate which area your organization focuses on MOST. If you do multiple types, please indicate that in the next question.

Number of Community Nav Staff

What software do you use for your resource database?

Accreditation Payment Preference How would you like the invoice to be set up? *For Inform USA members, we offer the ability to split the cost of Accreditation into two payments of $3,100 each; one installment must be paid prior to starting the process.

Estimated annual Community Navigation program budget: Gold or Silver applicants must indicate their annual budget.

Name of person completing Application & signing Consultation Agreement:

Contacts/calls per year (calls, emails, texts, chats or walk-in)

When does your current accreditation cycle end (list month and year)? For first time applicants, put NA. **Please note - organizations are allowed to apply for accreditation 1 year prior to when their current accreditation cycle ends. If you need to apply earlier than that for budgetary reasons, please contact accreditation@informusa.org to be considered on a case-by-case basis.

Lead - Years of Community Navigation Experience

Years of Community Navigation Work Experience - Alternate Contact

Years of Community Navigation Work Experience - Lead Database Staff

Size of Database Curation Team (# of FTE's)

Do you have any software conversions planned during your Accreditation process?

If you are required to go through Accreditation, please provide a description/reference (ex. name of contract, specific statute language)

Consent for Recordings of Meetings Do you give Inform USA permission to record the online meetings we have with your organization for training purposes (database review, virtual site visit)?

Do you subcontract a portion of your Community Navigation services to another organization? (If yes, please describe what portion of services (call handling, resource database, etc), and share the name of the subcontractor)

Lead Contact First Name

Lead Contact Last Name

Channels of Access In addition to phone, what other channels of access does your I&R program offer?

Classification System **Please note - If you are using a classification system other than 211HSIS, you will need to contact accreditation@informusa.org to begin the vetting process for an alternate system.

# of Agency/Org Records at Time of Application

Other DC Duties

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Accreditation Application (payment in full up front)

Accreditation

Let's Get Some Additional Information

Please complete the requested information below to finish adding Accreditation Application (payment in full up front) to your cart.

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