Application Form

 Please, return completed application form to Alliance of Church-Based Community Developers, 1345 South Burlington Avenue., Suite 204, Los Angeles, CA 90006.  Click here to download a PDF version of this application.

 1.ORGANIZATION PROFILE

  A.  Name: ______________________________________________________________

        Address: ____________________________________________________________

        City: ____________________________ State: _________ Zip: _________

        Telephone: (____) ____ - ______  Fax: (____) ____ - _____

        Contact: _____________________________ Since ________

         # of Board Members: ____________ Frequency of Board Meetings: ___________

         Number of staff: (Full-time) _______ (Part-time) __________

 B.  Briefly describe your organization's mission, history, and primary activities.

   I.  Mission:

C.   Why is your organization applying for this training program?  Give some expected benefits for your organization.

D.  List your current programs (if any):

 _____________________________________________________________________

 _____________________________________________________________________ 

_____________________________________________________________________

2.  Identify the geographical boundaries of your area serve.

North:                                                                South:

East:                                                                  West:

3.  ORGANIZATION'S REPRESENTATIVE PROFILE

      (Complete one page for each designated person.)

A. Identify the person(s) representing your organization at the VTR training program.

           Name: ____________________________________________________                  Title: ___________________________________

           How long with organization: ____________________________________________________________________________________       

           Any previous community development training?      Yes __ No __             If yes, where? _____________________________________

4.  BOARD AUTHORIZATION AND STATEMENT OF COMMITMENT (Complete one page for each designated person.)

 Whereas, Alliance of Church-Based Community Developers has distributed the application for admission to Community Outreach Ministries, Leadership and Organizational Development Training Program: and

Whereas, ____________________________________ (name of organization) is an organization that has a direct interest in the leadership and future development of its community: and

 Whereas, ____________________________________ (name of organization's representative) is designated to represent

 ______________________________________ (name of organization) throughout the course of the training program.

 Now, therefore, be it resolved that _______________________________________(name of organization) hereby authorizes

 ______________________________________ (name of organization's representative) to apply for participation in this training program.

 DATED:________________SIGNATURE:______________________________ (Pastor/Exec. Director)

DATED:________________SIGNATURE:_______________________________  (Chairperson, Board of Directors/Trustees)