Dress for Success Southern Nevada

Dress For Success Community Referral Partner Application

What's your email address?

Your information

Required fields are marked with an asterisk (*).
Name of Organization *
First Name *
Last Name *
Title *
Date *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Organization Address *
Telephone *
Mobile Phone

For example, 123-456-7890
What is your mission statement? *
What is the executive director's name?
What is the program director's name?
Who assists with, if any, vocational or job-development programs?
What is their email address?
Do you have federal 501(c)3 status? *
Does your agency have vocational or job-development programs? If so, please list them.
Who qualifies to participate in your programs? (i.e., public assistance, SSI, SSD, immigrants)
Do your participants have any special needs that Dress for Success Southern Nevada should be aware of in order to provide them with our services?
Do you provide ESL, GED or advanced degree/certification classes? Please specify.
What type of job development does your organization provide to applicants? Please list both hard and soft skills.
Do you provide industry specific training such as food preparation or accounting? Please specify.
Do participants take part in internships? Please specify.
How does your organization assist participants with their job search? Please describe the steps.
Do you have a job retention program? If so, please describe.
In addition to our Suiting Program, we offer a continuum of services. Would your clients benefit from?

If yes, how many a month do you think you might refer?
Do you provide vouchers or funds for professional attire?
Do you currently provide clothing to your clients and if so how?
How many participants per month do you estimate your organization will refer to Dress for Success Southern Nevada?

Terms & Conditions

Referral Agency Affiliation Agreement

Memo of Understanding

The purpose of this agreement is to form an affiliation between Dress for Success Southern Nevada and the organization named on this application. We, the above organization, having in common the goal of empowering low-income women who seek employment, shall facilitate the provision of services to all enrolled clients.

We agree to responsibly refer job-ready clients to Dress for Success Southern Nevada for interview appropriate clothing in accordance with Dress for Success Southern Nevada's policies and procedures.

We designate the undersigned contact person to serve as our sole liaison to Dress for Success Southern Nevada for all client
referrals. This contact person will attend Dress for Success Southern Nevada's orientation and annual member organization meeting.

In return, Dress for Success Southern Nevada agrees to suit clients with dignity and respect. Dress Southern Nevada reserves the right to revoke membership should a member organization or its representatives violate the states policies and procedures.