Partner Account Information Form

First Name *

Last Name *

Name Pronunciation

Email *

Phone

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

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What area of Los Angeles County do you work/spend most of your time? *

Antelope Valley

San Fernando Valley

San Gabriel Valley

Central/Metro L.A.

Westside

South LA

Eastside

Harbor/South Bay

Other (including outside of L.A. County)

It's helpful for us to know where you spend most of your time (whether it's work, home, or elsewhere). This helps us when considering geography-specific engagements or connecting you to other Partners in your neighborhood.

Other Geographic Area

If you chose "other" above.

Job Title

Company Name

Current Industry that you work in *

Private Sector

Public Sector

Homelessness

Consultant

Nonprofit

Foundation

Retired

Other

homelessnes

Work Sector Other

if you chose "other" above

Consulting Services

If you are a consultant, what types of consulting services do you offer?

Biography

Please give us a short bio (less than 200 words)

Your Expertise (select all that apply) *

Board Management

Coaching

Community Organizing

Executive Leadership

Fundraising

HR / Staffing

Information Technology

Legal

Marketing/Communications

Mission, Vision, Strategy, & Planning

Operations / Finance

Program Design, Management, Evaluation

Volunteer/Stakeholder Management

Workshop Training & Facilitation

Other

Expertise Other

if you checked "other" above

What inspired you to become an SJPLA Partner at this time?

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Birthday

Gender *

Pronouns *

If your pronouns aren't listed above, add them here.

Race *

American Indian or Alaska Native

Asian / Asian American

Black or African American

Hispanic / Latinx

Native Hawaiian or Other Pacific Islander

White

Multiracial

Decline to answer or Unknown

Languages Spoken *

LGBTQI+ Status *

Yes

Prefer not to share

Interests *

Civil Rights / Human Rights

Criminal Justice Reform

Disability Rights

Diversity, Equity & Inclusion

Education

Equitable Grantmaking

Ending Gender-Based Violence

Environmental Justice

Foster Care System

Healing Justice

Homelessness & Housing

Immigration Detention Reform

LGBTQIA+ Rights

Racial Justice / Anti-Racism

Transit & City Planning

Other

Instagram url

LinkedIn url

Event Considerations

Do you have any dietary preferences or food allergies? *

No preferences/allergies

Vegan

Vegetarian

Halal

Kosher

Pescatarian

Gluten Free

Other

If you checked "other" above, please describe here

Do you have any accessibility and/or mobility-related requests that we should be mindful of?

Emergency Contact *

Emergency Contact Phone Number *

Headshot Photo

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