Boys & Girls Clubs Alaska Profile Form



Alaska Nonprofit Organization Profile Form 21st Century Community Learning CentersNonprofit Organization Contact InformationName of organization: FORMTEXT Boys & Girls Clubs AlaskaLocation: FORMTEXT Anchorage, with 25 Locations Statewide, list included belowWebsite URL: FORMTEXT name: FORMTEXT Lauren MasonMailing address: FORMTEXT 2300 W 36th Ave, Anchorage, AK 99517Phone number: FORMTEXT 907-770-7371Email address: FORMTEXT lmason@Alaska Entity Number: FORMTEXT 36367D (Boys & Girls Clubs of Southcentral Alaska) - Club locations include Anchorage, Eagle River, Wasilla-Palmer, Goose Bay, Fairbanks, Utqiagvik, Kotzebue, Selawik, Noorvik, Kivalina, Nome, Emmonak, Saint Mary's, Mountain Village, Naknek, Togiak, Sand Point, Tyonek, Ketchikan, Saxman, Klawock, Kake, and Metlakatla. (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 -or after-school (or summer recess) programs and activities? FORMCHECKBOX Yes FORMCHECKBOX NoIf “Yes,” Number of years: FORMTEXT 51If “No,” give the name and contact information of the organization you will be formally partnering with who meets that criteria and who will provide mentoring and guidance to you:Name of organization: FORMTEXT n/aContact name: FORMTEXT n/aEmail address: FORMTEXT n/aPhone number: FORMTEXT n/aBriefly describe what relevant services your organization traditionally provides (400 character limit): FORMTEXT Boys & Girls Clubs work with school-aged youth and teens for outcomes in academic success, character and leadership development, and healthy lifestyles. The Clubs have a site-based positive youth development model that employs mentoring and focuses on building resilience in youth and teens. Academic enrichment and support, service learning, and physical activity are all components. 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: FORMTEXT Arctic Slope Community FoundationContact name: FORMTEXT Sharon Thompson, Executive DirectorEmail address: FORMTEXT Sharon.Thompson@Name of organization #2: FORMTEXT Nome Community CenterContact name: FORMTEXT Rhonda Schneider, Executive DirectorEmail address: FORMTEXT rschneider@Name of organization #3: FORMTEXT Stellar GroupContact name: FORMTEXT Iris Matthews, Alaska Native Education Program EvaluatorEmail address: FORMTEXT iris@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): FORMTEXT After-school and out-of-school time site-based academic enrichment activities, including homework help and tutoring in subject areas that encompass language arts, math, and science. Boys & Girls Clubs focus on the strengths, interests, and needs of youth to find what motivates and engages them. The Clubs are adept at breaking down the perception that learning and fund are mutually exclusive. The Clubs maintain, consistently update, and are constantly addint to a current battery of age and skill appropriate academic enrichment activities for youth and teens. 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): FORMTEXT No. The Clubs' strength is working on-site with local schools and school districts. 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: FORMTEXT Lauren Mason, Dir. of Educational ProgramsEmail address: FORMTEXT lmason@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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