New Provider Summary

SNAP Path to Work Reimbursement Project

Provider Summary Information

Project Overview:

Introduction and Agency Background:

Organization Name:

Address:

City

State

Zipcode

Mission Statement:

Agency Overview (Please provide a brief summary of the organization):

What are the hours of operation? (Please advise if you are operating remotely)..

Is the organization currently providing employment & training (E&T) services to clients?

Yes

What programs are you offering? How many programs would you be including in the budget?

Do you charge any participants for related training services, are there any fees associated with them completing your program?

Objectives, Goals, Target Population, & Geographic area to serve:

Objectives/Goals: Address how the project would enhance and/or expand E&T services in MA and meet the needs of the sector strategies in your community.

How will the program assist SNAP participants to increase their ability to obtain employment and/or promote wage progression?

What are the employment links from your proposed program to local jobs?

Which industries are hiring? Identify any new partnerships that would be developed as a result of your SNAP PATH TO WORK program. Describe how collaborations will occur between (existing and/or new) providers.

Target Population: Who are your proposed participants? How will they be referred to your agency? Why are you proposing to work with this specific target population?

Geographic Area Served: Will your program cover an entire county or region? Is this the entire area that your agency serves or are you focusing on a particular geographic area and advise of the towns that you would serve? Please specify your geographic target area and explain the reason for selecting this area.

What sort of funding sources does your organization have to provide SNAP Path to Work training services?

How do you assess potential participants and do you provide case management?

Do you provide transportation, childcare or other supports such as Test fees, uniforms, on an as needed basis? If so what are the average costs for:

Support

Amount

$per participant

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Please complete the following:

Project Contact Name:

Project Contact Phone Number:

Project Contact Email (please list all if more than one):

Contract Signatory Name:

Contract Signatory Phone Number:

Contract Signatory Email:

Data Custodian Name:

Any other information you would like us to know about your organization or programs:

If you are human, leave this field blank.