Coalition Application Step 1 of 6 16% HiddenCoalition Member (Hidden)Name* First Last Email* AffiliationsRoles and Affiliations (Select all that apply) Child Welfare Professional (CM, Licensing, etc.) Nonprofit Organization (Staff or Volunteer) Guardian ad Litem Out-of-Home Caregiver (Foster, Kinship, & Non-relative) Faith-Based Community/Church Advocate for Children Attorney Government Official Business Leader Affiliations (Optional)Name of Child Welfare Agency Job Title at Child Welfare Agency Name of Nonprofit Organization Job Title at Nonprofit Organization Out-of-Home Caregiver (Select All That Apply) Foster Parent Adoptive Parent Relative Caregiver (Kinship) Non-Relative Caregiver Name of Church or Faith-Based Community Role at Church or Faith-Based Community Name of Law Firm or Agency Role/Title within Government Name of Business Your Business Role/Title Submit LogoAccepted file types: jpg, png, gif, Max. file size: 5 MB.Want your logo included on our coalition website? Please attach it here in jpg, gif, or png format. Must be under 5MB in size. Additional Contact Info (Optional)PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code County* Hillsborough Pinellas Pasco Other Other County HiddenCounty* Which work group(s) are you interested in joining? Advocacy/Legislative/Legal Caregiver Support & Resources Mental Health/Human Rights Models & Evidenced-Based Interventions Quality Monitoring Trauma-Informed Care LAST STEP: Create AccountUsernameCreate Password* Enter Password Confirm Password CAPTCHA Δ
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