Survey & Form Center

2. 
4. STRiVIN' Participation Sign-up

   This form is to be completed by organizations receiving COMBAT funding to indicate in which STRiVIN' (Striving To Reduced Violence In Neighborhoods) neighborhood(s) they will be participating. STRiVIN' is a COMBAT initiative to bring together schools, police, mental health providers, social workers, faith-based leaders, concerned citizens and others to address violence in vulnerable neighborhoods.

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6. More Information
   What Is STRiVIN'?
7. STRiVIN' Meetings
   Calendar
8. STRiVIN' Referrals
   Social Services Referrals
10. — Organization's Name*
12. — COMBAT Funding Type*

    Check All That Apply

    1. Substance Abuse Prevention
    2. Violence Prevention
    3. Treatment
    4. Law Enforcement School-Based Initiative
    5. STRIVIN' Hub
    6. Prosecutor's Office
    7. Police (Not Law Enforcement School-Based Initiative)
    8. Family Court
    9. Youth Court
    10. None (My Agency Would Like To Participate In STRiVIN' Despite Not Receiving 2024 COMBAT Funding)
14. — STRiVIN' Neighborhoods

    In each designated STRiVIN' neighborhood, a non-profit organization receiving COMBAT funding serves as the hub, responsible for coordinating resources in the surrounding area. 
    
    (STRiVIN' meetings are usually conducted virtually through ZOOM.)

    MIDTOWN KANSAS CITY

    Greater Impact (Greater Metropolitan Church of Christ)
    3735 Wabash • Kansas City, MO 64109
    Director and Hub Resource Coordinator: Branden Mims
    (Meetings held first Thursday of every month)

    NORTHEAST KANSAS CITY
    
    The Mattie Rhodes Center
    148 N. Topping Avenue • Kansas City, MO 64123
    Director and Hub Resource Coordinator: Scott Wagner
    (Meetings held first Thursday of every month)

    SOUTH KANSAS CITY
    
    The Hope Hangout, (Hickman Mills Prevention Coalition)
    Hickman Mills School District’s Burke Academy
    11115 Bennington Avenue • Kansas City, MO 64134
    Director and Hub Resource Coordinator: Marva Moses
    (Meetings held second Thursday of every month)

    INDEPENDENCE

    Community Services League (Hawthorne Place Apartments)
    16995 Dover •  Independence MO 64056
    Director and Hub Resource Coordinator: Jennifer Manuleleua
    (Meetings held third Thursday of every month)

    RAYTOWN

    The Safe Zone (Sisters In Christ)
    6108 Blue Ridge Blvd. • Raytown MO 64133
    Director and Hub Resource Coordinator: Carolyn Whitney
    (Meetings held fourth Thursday of every month)

16. Which Neighborhood(s)?

    Check the box(es) of those STRiVIN' neighborhoods in which your organization would like to participate. Agencies may be assign to specific neighborhoods based on service locations and the needs of the neighborhoods.

    
    

    1. Midtown Kansas City
    2. Northeast Kansas City
    3. South Kansas City
    4. Independence
    5. Raytown
18. — STRiVIN' Meeting Attendees and/or Contacts

    Meeting Attendees: List those individuals within your organization who will or may be participating in STRiVIN' meetings. They'll receive meeting invitations, agendas, cancellation notices, and meeting minutes ONLY.

    STRiVIN' Contacts: List those individuals within your organization who will receive STRiVIN’ emails. The content of these emails includes, but is not limited to: flyers for community events, useful resources, volunteer work opportunities, etc.

20. Name*
21. Title*
22. e-mail*
24. Check One*

    1. Meeting Attendee
    2. STRiVIN' Contact
    3. Both
26. Name
27. Title
28. e-mail
30. Check One

    1. Meeting Attendee
    2. STRiVIN' Contact
    3. Both
32. Name
33. Title
34. e-mail
36. Check One

    1. Meeting Attendee
    2. STRiVIN' Contact
    3. Both
38. Name
39. Title
40. e-mail
42. Check One

    1. Meeting Attendee
    2. STRiVIN' Contact
    3. Both
44. Name
45. Title
46. e-mail
48. Check One

    1. Meeting Attendee
    2. STRiVIN' Contact
    3. Both
50. If you have more than four people, list them here:
52. — Signature

54. By typing your name in the "Signature" box below, you acknowledge that this "electronic signature" is valid to the same effect of a traditional handwritten signature.

56. Signature*
57. Date*
    Date
59. Title

    If not listed above

60. e-mail

    If not listed above

Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit Submit and Print

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