VKB Business Impact Partner Application

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Empowering the community to be the solution for children, families and workers in Virginia's child welfare system. Thank you for taking the lead in efforts to end the foster care crisis in Virginia. Please fill out all sections that apply to you and your business.

Business Name *

Business Address including city and zipcode (Primary Location) *

Business Owner/Decision Maker Name *

Business Phone Number *

Email Address *

Website

County (Primary Location)

Additional Contact Names/Phone/Email

Business Type (Retail, Restaurant, Medical, etc)

Number of Locations

Business Street Address including city and zipcode (Additional Locations) *

Region(s) (please check all that apply)

Northern

Central

Piedmont

Eastern

Southwest

How did you hear about the Business Impact Partner program?

Contacted by a representative of VKB.

Contacted by another business owner.

Attended a community meeting for business leaders.

Received information from an elected official.

Found information on a website.

Other:

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