Spanish Organizational Membership Form

Organizational Member: *

Executive Director:

Name of Principal Contact: *

Street Address: *

City: *

WA: *

ZIP: *

Primary Phone Number: *

Website:

Fax:

Email of Principal Contact: *

Services:

  Advocacy

  Health

  Mental Health

  Policy

  Research

  Case Management

  Immigration Legal Services

  Refugee Services

  Child Care

  Organizing

  Community Education

  Citizen Support

  ESL

  ESOL

  Job Training

  Job Placement

  Leadership Development

  Other Other Description:

Issues:

  Access to Higher Education

  Workers Rights

  Civic and Voter Participation

  Housing

  Workplace Representation

  Civil Rights and Civil Liberties

  Language Access

  Public Benefits

  Other Issues

 Other Issue Description:

How did you hear about us?:

 *

Which communities does your community serve?:

Primary geographic areas served::

Languages spoken by your clients or constituency::

What are the key issues that impact the communities you serve?: