Alaska Nonprofit Organization Profile Form – 21st Century ...



Alaska Nonprofit Organization Profile Form 21st Century Community Learning CentersNonprofit Organization Contact InformationName of organization: Story Works AlaskaLocation: Anchorage, AKWebsite URL: Contact name: Regan BrooksMailing address: 203 W. 15th Avenue, Suite 103, Anchorage, Alaska 99501Phone number: (907) 602-7428Email address: regan@Alaska Entity Number: 10029900(Assigned by SOA Dept. of Commerce, Community, and Economic Development)QualificationsDoes the organization have at least 3 years of experience running or working with before-school, after-school, or summer programs and activities? FORMCHECKBOX Yes FORMCHECKBOX NoIf “Yes,” give number of years: 5If “No,” give the name and contact information of the organization you will be formally partnering with that meets the three-year criteria and who will provide mentoring and guidance to you:Name of organization: FORMTEXT ?????Contact name: FORMTEXT ?????Email address: FORMTEXT ?????Phone number: FORMTEXT ?????Briefly describe what relevant services your organization traditionally provides (400 character limit): Story Works Alaska offers:- True, first-person Story Workshops for youth. Primary audience is high school youth, but workshops have been adapted for use with middle and elementary school youth. - College Essay Writing Workshops for high school juniors and seniors.- Youth Leadership Program opportunities for youth (podcasting, grant writing, leading workshops for younger youth, and more).List 3 organizations who are familiar with your organization’s work and can affirm the quality and history of your services:Name of organization #1: Spirit of Youth and Alaska Teen Media InstituteContact name: Karen ZemanEmail address: kzeman@, rosey@Name of organization #2: Alaska Humanities ForumContact name: Megan CacciolaEmail address: mcacciola@Name of organization #3: Anchorage Youth Development CoalitionContact name: Lindsey HajdukEmail address: lindsey@Possible Partnership ServicesBriefly describe what programming and services you are interested in and capable of providing in a 21st CCLC partnership (limit to 600 characters): Story Works Alaska would be interested and capable of providing:- Facilitation of personal storytelling workshops for youth (priority ages for us are 13-18, but we are open to working with ages 9-25).- College Essay Workshops to support youth and young adults writing college admissions and scholarship essays.- Professional development for educators who are interested in supporting true, first-person storytelling for youth in their programs and/or classrooms. - Support for the development of podcasts or other programs featuring youth sharing their stories.Are you interested in and capable of participating in a long-distance partnership using VTC, web conferencing, or other technological tools? (limit to 200 characters): Yes. We are capable of and interested in long-distance partnerships and our youth leadership program is currently developing additional resources to help support more long-distance partnerships.Assurances and UnderstandingsI verify all the profile information submitted is current and accurate I understand submitting incomplete and/or out-of-date profile information may result in my organization not being included in the pool I verify my organization is an Alaska non-profit entity in good standing I verify I am an employee or officer of the organization for whom I am submitting this profile information and have the authority to submit the information on the organization’s behalf I understand this solicitation for information will not result in a contract with the Alaska Department of Education & Early Development (DEED) nor does this listing represent an endorsement by DEED. The list will be posted (for informational purposes only) for any 21st CCLC grant applicant to view and utilize at their own discretion.By checking this box I verify the veracity of all information provided and my agreement with the “Assurances and Understandings” written above: FORMCHECKBOX Contact name: Regan BrooksEmail address: regan@Complete and send as an electronic, but not scanned, document to jessica.paris@ to request to be included in the Alaska 21st CCLC External Organization Partner Pool. Instructions for completing this form and information about the Alaska 21st CCLC External Organization Partner Pool can be found on the DEED 21st CCLC webpage. ................
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