Contact (515) 268-5142 with questions. You must have JavaScript enabled to use this form. Agency Contact Name Phone Number Email Address We have a clearly stated and legitimate purpose focused on meeting a recognized health or human service need in Story County provided to anyone in Story County who meets our client eligibility requirements. - Select -Yes No We are tax exempt under section 501(c)(3) of the Internal Revenue Code and under Chapter 504A of the Code of Iowa; or are a local, state, or federal government agency in the state of Iowa. - Select -Yes No All necessary licenses, permits, certification and/or accreditation to provide services are current and valid. - Select -Yes No If we are affiliated with parent organizations, we have written agreements which specify the relationship between local and parent organizations, including mutual responsibilities and accountabilities. - Select -Yes No We have written bylaws which clearly define our organization’s purposes and functions and provide for the orderly election of officers and for the terms, tenure and filling of board vacancies. - Select -Yes No We have a responsible and active board of directors, comprised entirely of volunteers, all of whom serve without compensation. The board is broadly representative of the community and of the people we serve. The board meets a minimum of four times a year. - Select -Yes No We do not exclude any person who seeks services from receiving any service based on the individuals race, ethnicity, color, creed, national origin, age, disability, gender, religion, sexual orientation or any other factor protected by any applicable law. - Select -YesNo We follow federal, state and local nondiscrimination laws and promote diversity in the selection of staff, board members and other volunteers. - Select -Yes No We operate in a defined and clearly identifiable area of community need. We clearly specify our program goals and provide services that meet the community need. Periodically we reassess the community need and modify program goals accordingly. - Select -Yes No Our facilities are suited to meet our purposes. Sites where direct services to clients are provided are appropriately located for the geographic area served. Our facilities are handicapped accessible and conform to the Americans with Disabilities Act. - Select -Yes No We operate under a balanced budget approved by our board of directors and account for funds in accordance with generally accepted accounting principles. - Select -Yes No If our annual budget is over $250,000, we conduct an annual financial audit by an independent certified public accounting firm. If our budget is $250,000 or less, we carry out an annual accounting of our financial activity as required by applicable laws. - Select -YesNo Are there policies and practices in place to incorporate an equity lens into your organization's work? - None -YesNo Do you have a plan to diversify your board and/or committees? - None -YesNo Do you provide staff training or development regarding DEI? - None -YesNo Do you regularly engage those you serve in decision making regarding programming that is intended to benefit them? - None -YesNo Submit Leave this field blank
