Organizational HOPE Certification Application template 1

Organizational HOPE Certification Application
Organization Information
Name of organization*
Organization website link*
City*
State*
Sector*
Sector (if Other):
YesNo
YesNo
Name of person completing the application:*

First NameLast Name
Role of person completing the application:*
Email of person completing the application:*
example@example.com
We maintain a publically accessible list of organizations with an active HOPE certification. By participating in the HOPE Organizational Certification program, your organization consents to being listed and potentially have your projects and outcomes featured on our website.

To view the list of HOPE certified organizations, visit: HOPE-Informed Organizational Certification
My organization would like to opt out of being featured on the HOPE website

HOPE Trainer Information
To apply for the HOPE-Informed Organizational Certification, each organization will need at least one HOPE Champion on staff to help guide them through the process. To learn more and register a staff member for Champion training, visit: HOPE Certification Programs | Tufts Hope (positiveexperience.org)

Please complete the following information about your HOPE Champion.
Yes, we have at least one trained HOPE Facilitator on staff at our organization.No, we do not have a HOPE Facilitator on staff yet.
Yes, we have a trained HOPE Champion on staff at our organization.No, we do not have a HOPE Champion on staff yet.
HOPE Champion Name

First NameLast Name
HOPE Champion Email
example@example.com

Registration Payment

Registration Fee*

HOPE Organizational Certification - Small Department

Registration for organizations interested in going through HOPE Organizational Certification. This registration applies to entities with fewer than ten staff.

$5,000.00 Quantity

HOPE Organizational Certification - Medium Department

Registration for organizations interested in going through HOPE Organizational Certification. This registration applies to entities with between 10-49 staff.

$7,500.00

HOPE Organizational Certification - Large Department

Registration for organizations interested in going through HOPE Organizational Certification. This registration applies to entities with between 50-150 staff.

$10,000.00 Quantity

HOPE Organizational Certification -Funder or Government Entity

Registration for organizations interested in going through HOPE Organizational Certification. This registration applies to funders or government entities that wish to offer Organizational Certification to their grantees.

$50,000.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Thank you for completing the application. Please press "Submit" below to send your application to the HOPE Team.

Please reach out to the HOPE Team at HOPE@tuftsmedicalcenter.org with any questions or concerns.
Should be Empty:

Organizational HOPE Certification Application

Organization Information

HOPE Trainer Information

Registration Payment