VCN Partnership Application

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Application Process: Partnerships are subject to approval by the VCN Board. Applications are forwarded to the Board of Directors, which meets quarterly. Dues are not payable until an organization has been accepted. Renewal invoices are sent annually.

Organization Name *

Director/Virginia Director *

Director/Virginia Director Email

Point of Contact *

Point of Contact Email *

Point of Contact Phone Number *

Mailing Address *

Organization Website

What is your organization's tax status? *

501(c)(3)

501(c)(4)

College or University affiliated organization

School Club

Non-Student Club

Trade Association

Other:

Is your organization non-partisan? *

Yes

Other:

How does your organization advance environmental policy in Virginia OR how does your organization plan to?
*

Why does your organization want to become a VCN Partner? *

Approximately how many members does your organization have?
*

Does your organization have any paid staff? If so, how many? *

Do you have an active Board of Directors or Steering Committee? If so, please list those members. *

Has your organization worked with a coalition or in a collaborative partnership in the past? If so, please elaborate. *

What is your organization's connection to Virginia? *

Virginia organization with office in Virginia

National/regional organization with office in Virginia

National/regional organization with staff in Virginia

National/regional organization with staff dedicated to Virginia

National/regional organization with no staff dedicated to Virginia, but does work specifically in Virginia

National/regional organization with no staff or dedicated work in Virginia

Other:

In which region(s) of the state does your organization do work? *

Statewide

Shenandoah Valley

Roanoke Region

Southwest

Southside

Northern Virginia

Piedmont

Capital Region

Northern Neck/Middle Peninsula

Eastern Shore

Tidewater/Hampton Roads

Other:

Required

Level of Partnership *

Bald Eagle – Statewide and regional groups with a staff of 10 or more – $2,500 or greater annual contribution

Cardinal – Statewide and regional groups with 5 - 10 staff members – $750 or greater annual contribution

Tiger Swallowtail Butterfly – Groups with 1 - 5 paid staff members – $300 or greater annual contribution

Dogwood – For volunteer groups that do not have paid staff – $100 or greater annual contribution

Are you applying for a dues waiver? VCN will consider a dues waiver for any organization with a budget under $100,000 whose mission is focused on environmental justice and/or conservation organizations primarily engaging communities not traditionally served by the environmental community (such as low-income communities or communities of color). Dues waivers will cover the full cost of a VCN partnership for 1 year. Groups will need to re-apply annually through the dues renewal process. There is no limit on the number of years a group can be awarded a dues waiver. Groups who are awarded a dues waiver will be listed as Dogwood partners and will receive the same partner benefits as all other Dogwood partners. Dues waivers will be approved by the board at the same time the board reviews and approves the application and will review each application annually after that. *
*

Yes

If yes, describe how your org predominantly works on environmental justice or in low-income communities or communities of color.

Does your organization have a conflict of interest policy?

Yes

Other:

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Does your organization have a Diversity, Equity, Inclusion, & Justice Policy?

Yes

Other:

Clear selection

If possible, please send a copy of a newsletter or other publication produced by your organization to admin@vcnva.org after submitting your application.

Submit

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