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.

**If you would like to split the application fee into two installments (of $3,100 each), please fill out the 2-Installment Application form instead of this one. Thanks! Once submitted, this order cannot be changed.

Non-Member Price: $9,000

Member Price: $6,000

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.

Date form is completed:

Agency/Organization Name:

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.

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

Legal Status

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

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.

Program name (for your Community Navigation program):

City and State/Province of Community Navigation program:

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

Your Community Navigation program's website:

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

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

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

Coverage area served: *This is important because the accreditation award from this cycle will apply only to these areas.

Number of Community Nav Staff

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)

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)

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

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

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

Lead Contact First Name

Lead Contact (job title):

Lead Contact Last Name

Lead - Years of Community Navigation Experience

Is it the Lead Contact's 1st Time thru Inform USA Accreditation? (If yes, this could qualify you for a Buddy, when available).

Lead Contact (email):

Lead Contact (phone number):

Alternate Contact (full name):

Alternate Contact (job title):

Years of Community Navigation Work Experience - Alternate Contact

Alternate Contact (email):

Alternate Contact (phone number):

Years of Community Navigation Work Experience - Lead Database Staff

Contact / Resource Data Software What software do you use for contact or resource data?

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

# of Agency/Org Records at Time of Application

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

Other DC Duties

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.

Database Contact (full name):

Database Contact (email):

Resource database maintained by another entity?

If externally maintained, please list name here:

Is that organization Accredited by Inform USA?

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)?

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.

Name of person completing Application & signing Consultation Agreement:

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