Teen Pregnancy & Prevention Partnership
ADD YOUR ORGANIZATION TO THE RESOURCE CENTER
NOTE: For organizations with multiple programs related to teen pregnancy prevention, we encourage you to complete a separate form for each program. Thank You!
Key:
*
Denotes required field.
GENERAL INFORMATION:
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Organization Name:
Organization's Mission:
PROGRAM DESCRIPTION:
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Program Name:
Active Since (M/Y):
Month
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January
February
March
April
May
June
July
August
September
October
November
December
Program Description:
(i.e. program model, service, location, etc.)
Eligibility Requirements:
(i.e. neighborhood, documentation, income requirements, etc.)
LOCATION:
Web Site:
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Street Address: (Line 1)
Street Address: (Line 2)
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City:
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State, Zip:
State
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NE
NM
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
Telephone:
Fax:
PRIMARY CONTACT PERSON:
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First Name:
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Last Name:
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Title:
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Email:
AREA(s) OF FOCUS:
Select the category that BEST DESCRIBES the area of focus in which your organization operates. You may select more than one category, but we ask that you try to find the best fit and select only one.
Academic Support
Parent & Adult Involvement
Job Training & Placement
Teen Health Services
Sexual Violence Prevention
Drug & Alcohol Prevention
Responsible Media Messages
Teen Parent Programs
Comprehensive Sex Education
Copyright © 2002 :: Teen Pregnancy & Prevention Partnership
