Public Allies Pittsburgh Placement Partner Application
Thank you for hosting an Ally for the Winter 2021 cohort. We look forward to working with you to build your capacity and develop emerging leaders for the region. If you have questions about this form or the selection and matching process, please contact Naomi Tannenbaum at naomit@publicallies.org or 412-513-9727. Thank you.
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Correo *
Organization Name *
Organization Website *
Street *
City *
State *
Zip *
Primary Contact First Name *
Primary Contact Last Name *
Primary Contact Email *
Primary Contact Phone *
Are you a 501(c)3; government agency; or 501(c)4 or 501(c)6 that does not engage in lobbying activities as defined under the Lobbying Disclosure Act of 1995? *
Organization's Mission *
Have you hosted an Ally before? *
Does your organization provide services that focus on any of the following areas? *
Check all that apply.
Obligatorio
How many Allies would you like to host *
In what general area will your Ally(ies) provide service for your organization? (Choose all that apply) *
Obligatorio
Please give a 3 or 4 sentence description of the service the Ally(ies) will provide to your organization. *
What is the primary outcome for the service your Ally will provide? In other words, at the end of the term, what do you want the Ally to have accomplished/changed/created?
Do you require the Ally to have a vehicle? *
Will the Ally have regular access to vulnerable populations? *
What is your funding source for the Ally stipend? *
Should the area go into a yellow or red phase because of COVID-19 or other emergency, would this position be able to be done partially or wholly in a virtual environment? *
We will be setting up interviews between Partners and Ally Finalists between December 1 - 11, 2020. Please let us know if there are dates during this timeframe when you are NOT available.
Please add any comments/clarifications on your answers, or submit questions you have.
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