SIFA Membership Application

SECTION 1: Organizational Information

1. Name of Organization:(Required)

Please provide the full legal name of your organization.

2. Address

Main office location (street, city, state, ZIP).

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3. Website

If applicable, provide the organization’s website.

4. Contact Person:

Name, title, and contact information for the primary point of contact for this application

Name:(Required)

Title:(Required)

Phone:(Required)

Email:(Required)

5. Type of Organization:

Is your organization a non-profit, government entity, or other? Please specify.

Non-Profit (501(c)(3))

Government Entity

Other

6. Year Founded:

7. Service Area:

List the geographic areas or communities served by your Family Resource Center (e.g., counties, cities, school districts).

SECTION 2: Services and Programs

1. Description of Services:

Please describe the primary services and programs provided by your Family Resource Center (e.g., parenting education, home visiting, early childhood programs).

2. Target Population:

Describe the population your FRC primarily serves (e.g., low-income families, new parents, children ages 0-5).

3. Languages Offered:

Please list the languages in which services are provided.

4. Partnerships and Collaborations:

List any key partnerships or collaborations with local agencies, schools, healthcare providers, etc

5. Program Impact:

Provide any available data or statistics on the impact of your services (e.g., number of families served, outcomes achieved).

SECTION 3: Alignment with Network Mission

1. Mission Alignment:

How does your organization align with the mission of the SIFA?

2. Core Values:

Please describe how your FRC embodies the network’s core values (e.g., familycentered, culturally responsive, equity-focused).

SECTION 4: Financial and Organizational Capacity

1. Annual Operating Budget:

Please provide a summary of your organization’s annual budget and major funding sources.

2. Sustainability Plans:

Describe any plans or strategies in place to ensure the long-term sustainability of your Family Resource Center (e.g., diversified funding sources, grants, community support).

3. Staffing Structure:

Provide an overview of your organization’s staffing structure, including leadership and key program staff.

SECTION 5: Commitment to the Network

1. Participation in Network Activities:

SIFA member centers are expected to participate in network meetings, training sessions, and collaborative activities. Please confirm your organization’s willingness to commit to these activities.

Yes

If no, please explain:

2. Data Collection and Reporting:

Members are required to collect and report data on service delivery and outcomes. Is your organization willing to comply with these requirements?

Yes

If no, please explain:

SECTION 6: Supporting Documents

Please attach the following documents with your application:

• Proof of 501(c)(3) status (if applicable)
• Most recent annual report or audited financial statements
• Program brochure or description of services
• Letters of support from community partners (optional)

Drop files here or

Max. file size: 50 MB.

SECTION 7: Authorization and Signature

By signing this application, you affirm that all information provided is accurate and complete, and you agree to uphold the guidelines and standards set forth by the Strengthening Indiana Families Association

Authorized Representative Name:(Required)

Title:(Required)

Signature:(Required)

Date:(Required)

Upon submission, your application will be shared with the following email addresses: sifa@fireflyin.org | DCSpreventionquestions@dcs.in.gov