Service Agency Contact Information

Service Agency name

Website

Main Contact

Main Contact First Name:

Main Contact Last Name:

Main Contact Title:

Main Contact Telephone:

Main Contact Email:

Alternate Contact

Alternate Contact First Name:

Alternate Contact Last Name:

Alternate Contact Title:

Alternate Contact Telephone:

Alternate Contact Email:

New Contact

Same as main contact

Service Agency Location

Single Location

Main Office

Branch Office

Main Office

Is your agency a branch of another agency? If so, please select the main office from the list below. If your main office is not listed below select "not listed"

Street Number

Apt/Unit Number

Street Name

Town/City

Province

Postal Code

Ship items to this address

Add more

Describing the Service Agency

What are your primary sources of funding? (select all the apply)

Federal Government

Provincial Government

Municipal/Local Government

Corporate Donors

Individual Donors

Fee for Service

Other

Describing your clients

Number of clients served in previous 12 months for:

Training Programs
Support Services

Types of clients served in the previous 12 months (please estimate %):

Under 30 years of age
55 years and older
No post-secondary education
Indigenous people
English/French as a second language
Recent immigrant within past 5 years
Member of a visible minority/racialized group
Member of LGBTQ2S+ community
People with disabilities/functional differences (e.g., physical, developmental, neurodiverse, behavioural, episodic)

Employment Sectors

STAC Implementation Considerations

Who is our contact at your service agency to onboard and update regarding training programming?

Onsite Contact First Name:

Onsite Contact Last Name:

Onsite Contact Title:

Onsite Contact Telephone:

Onsite Contact Email:

New Contact

Same as main contact

Same as alternate contact

I understand that individuals that contribute to the setting of the FPSC's competency standards, certifications, accreditations or training programs may be acknowledged from time to time (e.g. in printed material, social media, on the FPSC website).