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Ministry Partner Application

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This is a comprehensive application that is intended to give Save the Storks a holistic understanding of your pro-life ministry. Please take your time to fill out the questions thoroughly.

Contact Information

First Name

Last Name

Title

Ministry Phone

Ministry Name

Executive Director's or CEO's Name

EIN

Website

Social Media Links

Ministry Address Line 1

Ministry Address Line 2

City

State

Zip Code

Ministry Information

Mission and Strategy

Please provide your mission statement below, as well as an explanation of your mission.

When was the last time you reviewed or updated your mission statement?

Please provide your vision statement below (if applicable).

Do you have written Core Values?

Yes

Include them below.

Is your ministry considered both faith-based and pro-life?

Yes

When is your yearly planning or strategic planning meeting typically held?

What are your ministry’s goals for the next 3 years?

What is your organization’s policy regarding staff, volunteers, or board participating in any activities that could be considered violent, aggressive, or using shaming language towards women? (use of graphic abortion images, using the words murder or killing, shouting at women considering abortion, etc.)

Financial Practices and Fundraising

Please provide a detailed copy of a board approved annual budget from this current year and from the previous 2 years. The budget should be broken down by categories. There should be 3 separate budgets uploaded.

Click "Add another response" to upload multiple documents.

Please list all your fundraisers from the last year and how much each campaign raised.

Does your ministry have written financial controls and standards?

Yes

Please attach them here.

Does your ministry have federal tax exemptions?

Yes

Does your ministry have state tax exemptions?

Yes

Approximately, how many months of operating expenses do you have in savings?

Does your ministry participate in a yearly financial audit?

Yes

Are your ministry's restricted gifts separated from operating accounts?

Yes

Are you a 501(c)(3)?

Yes

Does your ministry receive any government funding? (Medicaid, Federal/State Grants, etc.)

Yes

How much funding does your organization receive annually from a government agency?

Ministry Operations

How many paid full-time staff currently work for your ministry?

How many paid part-time staff currently work for your ministry?

How many volunteers currently work for your ministry?

How many years has your ministry been in operation?

What client management software do you use?

Do you have written, and board approved policies and procedures for your staff and volunteers interfacing with clients?

Yes

Does your ministry currently offer medical services to clients?

Yes

Do you have written medical policies and procedures that have been approved by your overseeing Medical Director?

Yes

Client Services

How many total hours a week is your ministry open for clients?

What days and hours do you serve clients each week?

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Hours

Do you serve all clients regardless of their ultimate pregnancy decision?

Yes

Please check all services your Ministry currently offers to clients.

Pregnancy TestsUltrasoundsOptions CounselingMaterial resources for mom and child for up to 2 years after birth Professional Counseling Post-abortion RecoveryFaith based conversations based on appropriateness of client interaction 24-hour hotline or online chat for clients (OptionLine ok) Parenting education to families Men’s mentoring/educationMobile Ultrasound and Pregnancy TestsOther Services and Programs

If other, please explain here.

Please check all services your ministry outsources.

If other, please explain here.

Client Demographics

What is the average age of the clients that you serve in your ministry?

What is the total number of clients that you serve weekly?

Please include clients seen in classes, material resources, etc.

How many new clients do you serve weekly?

Of the new clients served weekly, how many are considered abortion vulnerable, abortion minded, or abortion determined?

What percentage of the total population in the communities you serve are between the ages of 16 – 25?

How many abortions take place annually in the communities you serve?

Staff/Leadership Standards

Board

What is your board minimum as per your by-laws?

How many board members do you currently have?

Do your board members have job descriptions?

Yes

How often are your board meetings held?

How is your board expected to contribute financially?

Do they meet these expectations?

Yes

What type of board do you have? (I.e. working, managing, governing, etc.)

In your opinion, what are your biggest board challenges?

How is the Executive Director’s or CEO's review and supervisory process executed?

Does the Executive Director or CEO attend board meetings?

Yes

Does the board have a written policy regarding conflicts of interest?

Yes

Does the board have an on-boarding process for each new member, and is it followed?

What yearly non-profit board related trainings does the board participate in?

Executive Director or CEO

Does your ministry’s Executive Director or CEO serve full time? (Relative to the hours that your organization is open)

Yes

If the Executive Director or CEO was suddenly not able to serve, what would happen to ministry operations?

Describe or upload the organizational chart for your ministry.

What yearly trainings does the ministry’s executive director or CEO participate in (online or in person)?

Staff and Volunteers

What yearly trainings does the ministry’s staff participate in (online or in person)?

What are the qualifications of the medical staff performing ultrasounds at your ministry?

Does a licensed Medical Director review ultrasound scans?

Yes

Does a licensed Medical Director oversee those performing ultrasound with yearly reviews?

Yes

Do staff receive yearly performance reviews by the Executive Director or CEO or managing supervisor?

Yes

Have Client Volunteers gone through LOVE approach, Serving with Care and Integrity, or equivalent training?

Yes

Are Client Volunteers reviewed or observed yearly by a staff member?

Yes

Do you have an employee handbook that is distributed to all staff, volunteers, and board members?

Yes

Marketing and Brand

Does your employee handbook include policies regarding social media and other online activity?

Yes

Do you have a Brand Standards Guide that is distributed to all staff, volunteers, and board members

Yes

What is your yearly marketing budget?

Who primarily oversees and/or conducts marketing efforts?

What avenues of marketing are you utilizing? (please be specific)

Who is responsible for responding to reviews, Facebook comments, social media engagement, etc.?

Please upload the following:

Logo

Brand Standards Guide

Screenshots of marketing emails. Please include at least 2 emails.

Click "Add another response" to upload multiple documents.

Photos of printed advertisements. Please include at least 3 photos.

Brochures, Flyers, Billboards, Bus stop ads, external signage, magazine articles, etc. Click "Add another response" to upload multiple documents.

Program Information

Why do you want to become a Ministry Partner of Save the Storks?

Are you affiliated with any other local or national pro-life ministries (CareNet, Heartbeat, etc.)?

Yes

Please list them below

Please provide 3 client reviews below: (Google, Yelp, Facebook, left in center, etc.)

What are your ministry’s goals for the next year in the Ministry Partner Program?

What are your ministry’s expectations of Save the Storks in the Ministry Partner Program?

Choose at least one Ministry Partner category that applies to your organization

PRC Ministry Partner: Your organization has or will have a “Brick & Mortar” Pregnancy Resource Center.New Stork Mobile Ministry Partner: Your organization is wishing to purchase a Stork Mobile Unit.New Independent Mobile Ministry Partner: Your organization is wishing to purchase or has recently purchased a Mobile Medical Unit, that is not a Stork Built MMU. If you already have the MMU, your organization has been active on the unit for less than a year.Established Independent Mobile Ministry Partner: Your organization operates a Mobile Medical Unit, that is not a Stork built MMU. Your organization’s Mobile Ministry has been active for at least a year.

PRC Ministry Partner

How many center locations does your ministry operate?

How do you accommodate women who require services/appointments outside of your normal operating hours?

Besides major holidays, what other times throughout the year does your center close?

(Ex: We shut down for 2 weeks in December)

Are your familiar with OSHA standards as they pertain to your center?

Yes

Do you own or lease your building?

Yes

Do you own or lease your building?

Yes

Please upload pictures of any facilities related to your operations. Please include at least 10 photos. Each photo should be labeled with location name (waiting room, exam room, etc.). Please include the following photos:
- Outside front of the building
- Street view (from the street near your center)
- All outside signage
- All counseling rooms
- Welcome area and/or waiting room
- All classrooms, if applicable
- All ultrasound rooms
- All material resource rooms
- Any other areas accessible to clients

Do you receive feedback frequently that your center is difficult to find, or GPS directions are inaccurate?

Yes

New Stork Mobile Ministry Partner

When do you plan to start actively fundraising for your MMU?

Do you have any donors with specific expectations of your mobile ministry, such as where you operate, how many hours you operate, or naming rights to the unit?

Yes

A donor donated money towards our MMU, and as part of that donation, we agreed to use our mobile at least 3 times a week

Please describe all donor requirements.

Have you thought through staffing for your MMU?

YesNo

If so, please list the different positions, whether they are paid staff or volunteers, and what their role on the MMU will be.

Have you thought through a budget for your mobile unit’s operating, maintenance, and repair costs?

YesNo

If so, what is your budget for your mobile unit’s operating, maintenance, and repair costs? (please exclude the purchase price of the mobile unit)

What laws/requirements does your area have regarding operating your MMU?

Electrical restrictions, idling laws, medical regulations, etc.

How do you plan to fundraise for the ongoing and operational cost of your mobile unit?

What impact would a Mobile Unit have in your community?

If your ministry does not operate a brick and mortar center, where will you refer your positive pregnancy test clients to?

New Independent Mobile Ministry Partner

Please submit photos of your MMU or the MMU you are looking to purchase.

Photos of all sides of the MMU exterior. Please submit at least 6 photos.

Click "Add another response" to upload multiple documents.

Photos of MMU Interior. Please submit at least 5 photos, including pictures of the bathroom

Click "Add another response" to upload multiple documents.

Photos of under the hood.

Click "Add another response" to upload multiple documents.

How do you plan to fundraise for the ongoing and operational cost of the mobile unit?

Do you have any donors with specific expectations of your mobile ministry, such as where you operate, how many hours you operate, or naming rights to the unit?

Yes

Ex: “A donor donated money towards our MMU, and as part of that donation, we agreed to use our mobile at least 3 times a week

Please describe all donor requirements.

Have you thought through staffing for your MMU?

Yes

If so, please list the different positions, whether they are paid staff or volunteers, and what their role on the MMU will be.

Have you thought through a budget for your mobile unit’s operating, maintenance, and repair costs?

Yes

If so, what is your budget for your mobile unit’s operating, maintenance, and repair costs? (please exclude the purchase price of the mobile unit)

What is the Make, Model, Year, and Mileage of the mobile unit you are looking to purchase or have recently purchased?

Make

Model

Year

Mileage

If possible, please attach a Vehicle Inspection Report for both the Chassis and the Clinic. All reports must be performed by a Certified Service Center.

Chassis

Clinic

Please attach all vehicle maintenance and repair records that you have in your possession.

Click "Add another response" to upload multiple documents.

Please attach the Car Fax for the vehicle if MMU is previously owned.

Please describe all current warranties associated with the MMU.

Do you plan to own, lease, or finance the MMU?

Please provide the name and address of where you will/did purchase the MMU.

Please provide the name and address for the builder of your MMU, if known.

Is the mobile unit new or previously owned?

Does your state require an inspection of your MMU to prove that it meets all applicable codes and regulations?

Yes

Please attach a copy of that inspection.

What laws/ requirements does your area have regarding operating your MMU?

Electrical restrictions, idling laws, medical regulations, etc.

What provides power to the “Clinic” section of your mobile unit?

Inverter, generator, shore power, Volta system, etc.

Does the MMU have features that provide privacy and safety to clients such as locking doors, privacy screens, emergency exit windows, security camera system, etc.?

Yes

Please select features.

Locking DoorsPrivacy ScreensEmergency Exit WindowsSecurity Camera SystemOther

If other, please list

Does your MMU have internet access?

Yes

If so, please describe access.

Are there any known repairs or issues currently with your MMU?

Yes

If so, please explain.

If your ministry does not operate a brick and mortar center, where will you refer your positive pregnancy test clients to?

What impact would a Mobile Unit have in your community?

Have you started seeing clients on your MMU?

Yes

If so, for how long?

Established Independent Mobile Ministry Partner

Please submit photos of your MMU.

Photos of all sides of the MMU exterior. Please submit at least 6 photos.

Click "Add another response" to upload multiple documents.

Photos of MMU Interior. Please submit at least 5 photos, including pictures of the bathroom

Click "Add another response" to upload multiple documents.

Photos of under the hood.

Click "Add another response" to upload multiple documents.

How do you typically fundraise for the ongoing and operational cost of your Mobile Unit?

Do you have any donors with specific expectations of your mobile ministry, such as where you operate, how many hours you operate, or naming rights to the unit?

Yes

Ex: “A donor donated money towards our MMU, and as part of that donation, we agreed to use our mobile at least 3 times a week

Please describe all donor requirements.

When you acquired your MMU, was it new or previously owned?

What is the Make, Model, Year, and Mileage of the mobile unit you are looking to purchase or have recently purchased?

Make

Model

Year

Mileage

What is your center’s current budget for the MMU’s operating, maintenance, and repair costs? Please attach budget if available.

Please provide what the expenses for your mobile unit have been for the last 3 years. Please attach a Budget vs Actual Report if available.

What different positions do you require to operate your Mobile Ministry?

How many of those positions are volunteer staffed?

How many of those positions are filled by paid staff?

How many days per week is your mobile unit active?

How many months per year is your mobile unit active?

On average, how many clients do you see per month on your unit?

Of the clients you see on a monthly basis, how many are considered abortion vulnerable, abortion minded, or abortion determined?

Please provide at least two mobile client testimonials or reviews.

If possible, please attach a Vehicle Inspection Report for both the Chassis and the Clinic. All reports must be performed by a Certified Service Center.

Chassis

Clinic

Please attach the Car Fax for the vehicle if MMU is previously owned.

Please attach all vehicle maintenance and repair records that you have in your possession.

Click "Add another response" to upload multiple documents.

Please describe all current warranties associated with the MMU.

Do you plan to own, lease, or finance the MMU?

Please provide the name and address of where you will/did purchase the MMU.

Please provide the name and address for the builder of your MMU, if known.

Does your state require an inspection of your MMU to prove that it meets all applicable codes and regulations?

Yes

Please attach a copy of that inspection.

What laws/ requirements does your area have regarding operating your MMU?

Electrical restrictions, idling laws, medical regulations, etc.

What provides power to the “Clinic” section of your mobile unit?

Inverter, generator, shore power, Volta system, etc.

Does the MMU have features that provide privacy and safety to clients such as locking doors, privacy screens, emergency exit windows, security camera system, etc.?

Yes

Please select features.

Locking DoorsPrivacy ScreensEmergency Exit WindowsSecurity Camera SystemOther

If other, please list

Does your MMU have internet access?

Yes

If so, please describe access.

If your ministry does not operate a brick and mortar center, where will you refer your positive pregnancy test clients to?

What impact does your Mobile Unit have in your community?

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