Gap Year Association · Membership Application: Program Providers

Company/Organization Name *

Website *

Contact Information

Name of Primary Contact *

First Name

Last Name

Job Title of Primary Contact *

Phone Number of Primary Contact *

Email of Primary Contact *

Verify Email *

Business/Organization Mailing Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Program Provider Information

Business Designation *

501c3 Charitable Non-Profit

Limited Liability Company (LLC)

Sole Proprietorship

B-Corp

S-Corporation

Other

Organization/Business Annual Budget (in USD): *

$0 - $100,000

$100,000 - $250,000

$250,000 - $500,000

$500,000 - $1,00,000

$1,000,000 - $5,000,000

$5,000,000 +

Number of Full Time Equivalent Employees (FTE): *

0 - 5 FTE

5 - 10 FTE

10 - 25 FTE

25 - 50 FTE

50 + FTE

Geographic areas in which you have program operations: *

Provider level *

Please select your appropriate number of high school graduates, between the ages of 17 and 24, that your organization annually serves in order to determine your provider membership dues. Upon approval of your membership, GYA will send you an invoice for your annual dues. Student enrollment numbers are based on total numbers of students regardless of country of origin. Providers that have been offering programming for 17-24 year old high school graduates for less than two years will be considered for the "new and emerging" membership level.

Please upload your logo as a .jpg or.png *

Please provide your business/organization mission statement. *

Please provide a brief description of your company/organization (in third person, using non-sales language) for the GYA website. *

Examples can be found at http://www.gapyearassociation.org/providers/

Describe the elements of experiential learning that take place on your program. *

What age ranges do you accept on your program? *

During what seasons does your program operate? (check all that apply) *

Fall

Winter

Spring

Summer

What is the duration of your program? If you operate multiple programs, check all that apply. *

Less than 30 days

1-3 months

3-6 months

6-8 months

8-12 months

More than 12 months

Does your program have rolling admission/end dates or pre-determined start/end dates? *

Rolling Admissions

Pre-determined start and end dates

Do you accept students to your program who have been mandated by parents, counselors, medical professionals, or law enforcement professionals? *

Yes

No

Does your organization demonstrate ethical volunteer practices and reciprocity in intercultural partnerships? *

Yes

No

Unsure

Not applicable

URL where we can find your Policies on Diversity & Inclusion:

URL where we can find Student Policies/Code of Conduct:

URL where we can find your Essential Eligibility Criteria:

Please upload your Risk Management Plan as a .pdf

Evidence that you have been in business for at least 2 years

Examples include state registration documents, tax records, bills, etc.

For Programs Less Than Two Years Old

Programs that have been in operation for less than two years will be considered on a case-by-case basis and may require additional review by GYA's Membership Committee and/or administrative staff.

If your organization has been in operation for less than two years, please provide your business plan.

This must include an Executive Summary and suggest that your company/organization has considered its longevity, finances, and professionalism.

If your organization has been in operation for less than two years, please provide the resumes/CVs of all executive staff.

Additional Contacts

Please share the names, job titles, and emails for up to five additional contacts at your organization. We will include these individuals in GYA related correspondence related to special announcements, the monthly newsletter, and professional development opportunities.

Name

First Name

Last Name

Job Title

Email

Verify Email

Name

First Name

Last Name

Job Title

Email

Verify Email

Name

First Name

Last Name

Job Title

Email

Verify Email

Name

First Name

Last Name

Job Title

Email

Verify Email

Name

First Name

Last Name

Job Title

Email

Verify Email

PROGRAM PROVIDER MEMBERSHIP APPLICATION

Contact Information

Program Provider Information

For Programs Less Than Two Years Old

Additional Contacts