New Partnership Inquiry
Thank you for your interest in taking the next step towards a partnership with Healthy Steps Diaper Bank!

We will review your responses and take them into consideration with our current capacity and the need to avoid duplication of services in an area.

If you have any questions, please email Amanda at abarnes@healthystepsdiaperbank.com

* Completion of this form does not guarantee partnership.

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Email *
Name of the person completing the form *
Name of your organization *
Organization's website *
Is your organization a 501(c)(3)? *
Is your organization in good standing with your national affiliates or parent organization (if applicable)? *
What counties does your organization serve? (check all that apply) *
Required
If your organization serves only a specific area within a County, please type that area below.
Do you have a case management system that is working to address the root cause of poverty? *
Do 80% of the clients for whom you anticipate ordering diapers fall below the federal poverty line? *
In 2 or 3 sentences please share how your organization helps families in our community. *
Are you able to collect and report data regarding distribution? *
Are you able to come to Mission Central (5 Pleasant View Drive, Mechanicsburg) once a month to pick up your diaper order? *
Approximately how many children do you anticipate ordering diapers for each month? *
A copy of your responses will be emailed to the address you provided.
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