Name of Contact Person*

Phone Number*

Email*

Name of Organization

Type of Organization
Non-ProfitBusinessGrassroots OrganizationProgram RepresentativeChurch or Ministry GatheringCommunity or EducationalHealth or Wellness

Briefly describe your organization or program and how you learned about Sojourner Truth Place?

# of People served by your organization monthly (no duplicates)

Organization Zip Code

Number of paid staff at your organization
1 to 5 paid staff6 to 10 paid staff10 plus paid staffNo paid staff yet

What percentage of people served annually at your organization are at or below the poverty line?
0%5%10%25%50%75%100%

What percentage of people served annually at your organization identify as male?
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What percentage of people served annually at your organization identify as female?
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Average Ages of People Served at your organization *
Ages Birth to 4Ages 5–17Ages 18–24Ages 25–64Ages 65+No one served yet

What percentage of people served annually at your organization identify as LGBTQ?
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What percentage of people served annually at your organization are racial/ethnic minorities?
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What percentage of your organization's leadership &/or board members are racial/ethnic minorities?
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Sojourner Truth Place (or STP) connections *
Learn the STP Story & ServicesJoin STP Village or Ally with USSupport STP Services or EventsTour or book STP SpaceReserve a STP Vendor TablePurchase STP venue services