Workplace Solutions, Building a healthy workforce.

• Company/Organization:
  
• Headquarter Address:
  
• City:
  
• State:
  - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip Code:
  

• Team Development Volunteer Leader
• Name:
  
• Address:
  
• City:
  
• State:
  - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip Code:
  

• Email Address:
  
• Phone:
  
• Fax:
  

• Fundraiser Development Volunteer Leader
• Name:
  
• Address:
  
• City:
  
• State:
  - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip Code:
  

• Email Address:
  
• Phone:
  
• Fax:
  

• Senior Leadership/CEO sponsors of Making Strides National Team Program
• Name:
  
• Title:
  
• Name:
  
• Title:
  

• Please answer the following questions:

• Why is your company/organization interested in the Making Strides NTP? Are there particular benefits your company/organization is interested in or goals you would like to achieve? (i.e. team-building, employee/member engagement, local or nationwide recognition, etc.)

• Has Senior Leadership/CEO approved your company’s participation in the Making Strides NTP?
• Yes     No

• Has there been any discussion about how Senior Leadership/CEO will be engaged internally to promote/endorse/support the Making Strides NTP? (Existing NTP members indicate one of the top reasons for success is engagement of Senior Leadership/CEO.)
• Yes     No
• 
• If yes, please share their engagement.
  
• 
• If no, please share when this discussion will occur and your initial ideas on when Senior Leadership will begin engagement?

• Has there been any discussion about how your company/organization will internally communicate your Making Strides NTP involvement and your ongoing support of your company’s/organization’s team leaders and walk participants? (i.e., through district manager meetings, chapter meetings, company newsletter articles, conference calls, intranet postings, interoffice memos, meetings)
• Yes     No
• 
• If yes, please share communication/support plans.
  
• 
• If no, please share when communication/support plans will be developed

• If your company/organization is not currently a local sponsor of Making Strides, are you interested in learning more about this opportunity to provide your company/organization additional exposure and recognition?
• Yes     No
• 
• If yes, please share the market(s) in which you would be interested in learning more about local sponsorship opportunities:
  
• 
• If yes, how would sponsorship be coordinated?
• Centralized through the headquarters
• Decentralized, through individual locations

• How do you plan to internally recognize your employees/organization for their involvement in the Making Strides NTP?

• Does the American Cancer Society meet your guidelines for the following:
• 
• Matching Gifts?
• Yes    No
• Please explain:
  
• 
• Corporate Foundation Funding?
• Yes    No
• Please explain:
  
• 
• Community Volunteer Program Funding?
• Yes    No
• Please explain:
  

• Will your company/organization be able to provide an accurate list of contact names, e-mail addresses and phone numbers for each of your locations by March 15 for May events and May 15th for October events?
• Yes     No
• 
• If no, please explain:
  

Please email any documents that would be beneficial for us to encourage participation in these programs in local communities to acsworkplacesolutions@cancer.org