Agency / organization application

Apply as an agency, organization, nonprofit, church, camp, event, or program.

Use this application if your group provides care, support, programs, camps, events, or community services. Your group completes a review process instead of the individual background-check upload requirement.

1. Organization Information Organization name Organization type Website City and state served Upload logo Program description

2. Contact and Verification Primary contact Contact title Email Phone Business license, nonprofit ID, or registration number Upload verification document Staff screening process

3. Services and Rates Services offered Requested rate or fee structure Minimum booking or program requirement Payment or program notes

4. Provider Payment to Join

Organization membership required

Your payment and required organization verification records must be submitted before Hope Care Connect can update your business, agency, organization, nonprofit, church, camp, event, or program to the provider network. Payment does not guarantee approval or placement on the platform. If a required record is not available yet, you can save the draft and come back later.

Provider membership payment is non-refundable once Hope begins reviewing your application.

Monthly Provider Payment - $25 Yearly Provider Payment - $150

Provider membership choice I understand payment and required records must be submitted before this organization can be added to the provider network. I understand provider membership payment is non-refundable once Hope begins reviewing this application.

5. References and Consent Reference 1 name and contact Reference 2 name and contact I understand Hope reviews organization details before any listing is added. I understand the organization is responsible for following laws, licensing rules, insurance requirements, and program standards.

6. HES Review Alphabetized listing category HES has reviewed the application, verification records, and approval details before listing.

Your email app will open so you can send this information to Hope Care Connect.