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Program Fact Sheet
Please complete a separate fact sheet for each program within your agency in which Arbor's services will be utilized. The Program Name you list will be used for invoices, requesting staff, and conveying information to Arbor's field staff, in conjunction with your Organization/Agency name.
The use of the following information is intended to help Arbor Associates
professionals meet their obligations. Any information that you provide will be helpful in placing appropriate employees and is appreciated. Information can be updated in the future as needed. Thank you.
General Program Information
*
Indicates required field
Organization / Agency Name
*
Program / House Name
*
Program Street Address
*
Line 1
Line 2
City
State
Zip Code
Country
Program Phone Number
*
Program Fax
*
Website
*
Primary Contact
*
First
Last
Primary Contact's Title
*
Primary Contact's Phone
*
Primary Contact's Email
*
After-Hours Phone Number
*
Vital for communication regarding call-outs, tardiness, or other unforeseen circumstances.
Emergency Contact
*
First
Last
Emergency Contact Phone
*
Emergency Contact Email
*
Please provide the name and contact information of at least one other person from your organization who is authorized to request Arbor staff and/or discuss any issues:
2nd Contact's Name
*
First
Last
2nd Contact's Email Address
*
3rd Contact's Name
*
First
Last
3rd Contact's Email Address
*
2nd Contact's Title
*
2nd Contact's Phone Number
*
3rd Contact's Title
*
3rd Contact's Phone Number
*
Timesheet Approver's Name
*
First
Last
The designated Time Sheet Approver MUST be listed above as a contact. It does not have to be the same person who will be billed for services rendered. Arbor field staff (aka "Associates") who work at your program are required to complete Arbor timesheets on a weekly basis. Before being paid for hours worked, their timesheets must be approved by your organization by the weekly due date via Arbor's online portal. Please choose a Timesheet Approver who will be able to confirm or refute the Arbor Associate's timesheet of hours actually worked. Should you have any questions about whom to assign as the Timesheet Approver, please contact us.
Billing Information
Contact Name for Invoices:
*
First
Last
Billing Contact's Title
*
Billing Phone Number
*
For questions regarding invoices.
Billing Email Address
*
Email where invoices and billing communication should be sent.
Billing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Program Details
Program Type(s)
*
Residential - Group Home
Residential - Independent Living
Residential - Support in Family Home
Personal Care (Hygiene, feeding, etc.)
Day Program / Vocational
Staff Secure
Emergency Shelter / Respite
Transitional Housing
Foster Care / Adoption Agency
Teen Pregnancy / Parenting Education
Hospital
Special Education
Early Education / Child Care
Other
Other:
*
Program details / description
*
Include any details that would be helpful to Arbor staff such as mission, special consumer challenges, treatment method, etc.
Staff to Consumer Ratios
*
Consumer Challenges / Population(s)
*
Intellectually / Developmental Disabled
Physically Disabled / Handicapped
Mental Health / Behavior Challenges
Substance Abuse
Dual Diagnosis
Physical and/or Sexual Assault Victims
Physical and/or Sexual Assault Perpetrators
Homelessness / Housing Insecure
Refugee / Immigrant
ESL - If yes, indicate native language(s)
None
Other
Please detail any "other" in program description field or under program details/description.
Other / Details
*
Consumer Age(s)
*
Infant - 24mth
Toddler
Preschool-Kindergarten
Elementary School Age
Adolescent / Teen
Adult (18+)
Elderly
Consumer Age Range
*
Consumer Gender(s)
*
Co-Ed
Female Only
Male Only
Transgender
Staffing Requirements & Information
Job Description and Expectations for Arbor Staff
*
Is an orientation manual on the site for our staff?
*
Yes
No
N/A
Dress Code for Arbor Staff
*
General emergency procedures
*
Will Arbor Staff be required to restrain or have intervention certification? If yes, type:
*
TCI
CPI
HWC
Other
N/A
Other
*
Other Skills Required for Arbor Staff (All have First Aid/CPR)
*
MAP (Med-Cert)
Hygiene
Lifting / Ambulatory
Early Education Certified
Administrative / Office Skills
Elder Care
Other
Other (details)
*
Will Arbor Staff be required to complete program-specific certification or training?
*
Yes
No
(example: hospital orientation)
Gender requirements for Arbor placement
*
None
Yes - place female staff only
Yes - place male staff only
Depends on shift / current population
Getting There
Are GPS-enabled devices accurate for driving directions?
*
Yes
No
If not, provide driving directions below.
List any useful landmarks or details about location.
*
Details such as "white house on corner of Street X and Street X".
Is On-Site Parking Available?
*
Yes
No
Is program available via public transportation?
*
Yes
No
If Yes, Public Transportation details
*
Route, train, bus #'s, etc.
Fact Sheet completed by:
Name
*
First
Last
Date
*
Please click gray "Submit" button below when finished. Thank you!
Privacy policy. This privacy policy sets out how Arbor Associates uses and protects any information that you give Arbor Associates when you use this digital form. Arbor Associates is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this digital form, then you can be assured that it will only be used in accordance with this privacy statement
.
*Security on our intranet is treated seriously. We undertake security steps, including SSL technology, to protect customer account information and data transmissions.
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Arbor Team
Faces of Arbor
Share Your Story
Inside Arbor
Make Our Day!
Reviews
Ask the Expert
Branches
N. Andover Branch
Auburn Branch
Cranston Branch
Malden Branch
Wellesley Branch
Western MA / CT
Office Staff Page
Social
The Provider
Massnonprofit News
Blog
ASA
Boston Biz Journal Health Care
Resources