SIFA Membership Application SECTION 1: Organizational Information1. Name of Organization:(Required)Please provide the full legal name of your organization.2. AddressMain office location (street, city, state, ZIP). Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 3. WebsiteIf applicable, provide the organization’s website. 4. Contact Person:Name, title, and contact information for the primary point of contact for this applicationName:(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 Programs1. 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, etc5. 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 Mission1. 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 Capacity1. 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 Network1. 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 No 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 No If no, please explain:SECTION 6: Supporting DocumentsPlease 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 Select files Max. file size: 50 MB. SECTION 7: Authorization and SignatureBy 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 AssociationAuthorized 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