Thank you for your commitment to supporting job seekers and employers in the Chicago region. The following survey must be completed for each proposal submitted in response to the 2023 WIOA Youth Delegate Agency RFP released by The Chicago Cook Workforce Partnership. RFP Respondents must complete this survey by 4pm on April 12, 2023.

Organization Headquarters

Organization Name *

Organization's Headquarters Address *

Organization's Headquarters Address Line 2

City *

State *

Zip Code *

Number of Years in Business: *

FEIN Number: *

DUNS Number:

Type of Organization: *

Delegate Agency Information

Proposed Geographic Area Served *

Proposed Target Population Served *

Program Site Address *

Program Site Address Line 2

City *

State *

Zip Code *

Proposed Number of Out of School Youth Served:

Amount Requested for Out of School Youth

What is your cost per participant for Out of School Youth?

Proposed In School Youth Served

Amount Requested for In School Youth

What is your cost per participant for In School Youth?

Brief Program Description: *

Organization Demographics

Total Number of Employees *

What percentage of your organization's senior leadership are Black/African American? *

What percentage of your organization's senior leadership are Hispanic? *

What percentage of your organization's senior leadership are Asian? *

What percentage of your organization's senior leadership identify as multi-racial or non-White? *

CEO/Executive Director

First Name *

Last Name *

Email Address *

Phone Number *

What is the race/ethnicity of your organization's ED/CEO or equivalent? *

If you answered other or biracial and wish to share more information, please do so here:

BOARD PRESIDENT

First Name *

Last Name *

Email Address *

Phone Number *

What is the race/ethnicity of your organization's Board President or equivalent? *

If you answered other or biracial and wish to share more information, please do so here:

BOARD TREASURER

First Name *

Last Name *

Email Address *

Phone Number *

What is the race/ethnicity of your organization's Board Treasurer or Equivalent? *

If you answered other or biracial and wish to share more information, please do so here:

BOARD OF DIRECTORS DEMOGRAPHICS

What percentage of your organization's Board of Directors are Black or African American? *

What percentage of your organization's Board of Directors are Hispanic? *

What percentage of your organization's Board of Directors are Asian? *

What percentage of your organization's Board of Directors identify as multi-racial or non-White? *

Primary Point of Contact for RFP

First Name *

Last Name *

Phone Number *

Email Address *