KPB Affiliate Application - Keep PA Beautiful

Application for KPB Affiliation

Have questions? See the benefits and requirements here. If you have further questions, please contact Kylie McCutcheon, Affiliate Coordinator, at kmccutcheon@keeppabeautiful.org or 724-836-4121 ext. 114.

Interested in starting a local Keep PA Beautiful affiliate? Please fill out the application form below and we will be in touch with the next steps.

If you are not able to complete the form in one session, please use the "Save and Continue" link at the bottom of the form. This will give you a link, good for 30 days, to return and continue your form.

Applicant Contact Info

Today's Date(Required)

MM slash DD slash YYYY

Agency/Organization Name(Required)

Organization Contact Name(Required)

First Last

What pronouns do you use?

She/Her

He/Him

She/They

He/They

They/Them

Prefer not to answer

Other

Phone Number(Required)

Email(Required)

Enter Email Confirm Email

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Allegheny, Berks, York, etc.

Organization Background Information

Which of the following best represents your current organizational structure?(Required)

501(c)(3)

Program of a 501(c)(3)

Municipal or county government department

Program of Quasi-governmental agency such as an Authority or Conservation District

Other

Applicable Organization Documents(Required)

Applicable documents must accompany the application for certification. Please check which documents are included with the application.

Articles of Incorporation (Nonprofit Corporation)

Bylaws (Nonprofit Corporation or Government Entity Group or Subcommittee)

Resolution/Executive Order/Ordinance establishing Organization (Government Entity)

Guidelines for board appointment, subcommittee appointment, meetings, and/or officers (Government Entity)

Please upload the organizational document(s) indicated above

Please use your organization name in the file name so we can match up the documents to your application. Ex: xxNonprofitBylaws.pdf

Drop files here or

Accepted file types: docx, doc, pdf, jpg, jpeg, png, heic, rtf, Max. file size: 128 MB.

Tell us a few things you already are doing that aligns with community improvement programming.(Required)

Does your organization already lead or conduct community improvement programming or are you looking to expand your programs with the help and support of KPB?

What are three things you are hoping to get out of your affiliation with KPB?(Required)

Networking

Funding

Supplies

Technical Assistance

Education Tools

Brand Affiliation

Other (enter below)

Other affiliation benefit(s)(Required)

Has your organization previously participated or partnered with KPB?(Required)

Yes

Briefly describe how your organization has participated or partnered with KPB.(Required)

We have found that while administrative duties of affiliation are not terribly cumbersome, it is imperative that they are assigned to a staff person and that staff person serves in the role of Affiliate Coordinator.

Do you anticipate assigning affiliate duties to a staff position?(Required)

Yes

Please enter the name and contact info for the staff person who will take the role of Affiliate Coordinator

Staff Person Name(Required)

First Last

Staff Person Title(Required)

Staff Person Email(Required)

Enter Email Confirm Email

Staff Person Phone(Required)

What is the area that your agency operates within? (name of county(ies), municipality(ies), neighborhood(s), etc.)(Required)

What is the approximate population of your operating area?(Required)

Please enter a number from 100 to 10000000.

Does your oganization currently use social media?(Required)

Yes

If so, what are your social media links or handles that could be used to promote your KPB events and news? Skip any that you don't use.

Website:

LinkedIn:

Facebook:

Instagram:

X / Twitter

Other Social Media

Community Advisory Team

Each affiliate is required to have a Community Advisory Team. The advisory team advises and supports the affiliate through decisions and projects (similar to a board).

Many affiliates strive to have meetings every other month or once a quarter with their advisory team.
There is no minimum or maximum amount of people required; however, we strongly suggest a minimum of four people that represent a variety of backgrounds from the community, such as:
- Volunteer
- Public Official
- Individual from the for-profit sector
- Individual from the nonprofit sector

Please provide a list of names and emails that will serve as your Community Advisory Team. If you do not have an Advisory Team yet, we will develop it as part of the affiliation process. (word doc upload- not required)

Do you have a Community Advisory Team set up already?(Required)

This is not required to apply for affiliation. If you do not yet have an advisory team, we will develop one as part of the affiliation process.

Yes

Please upload a file (ie Word or Excel) listing the names, titles, and emails of who will serve as your Community Advisory Team.(Required)

Drop files here or

Accepted file types: docx, doc, xls, xlsx, pdf, txt, Max. file size: 128 MB.

Logo Design

Keep Pennsylvania Beautiful will provide you with a logo, as affiliates are strongly encouraged to utilize the state’s branding. If you have an existing logo, we will provide you with a lock-up that reads “Keep Pennsylvania Beautiful Affiliate” for you to add under your logo.

Do you have an existing logo?(Required)

Yes

Please upload your existing logo.(Required)

Drop files here or

Accepted file types: ai, pdf, bmp, heic, eps, jpg, jpeg, psd, png, svg, docx, doc, tif, tiff, webp, Max. file size: 128 MB.

If you don't have an existing logo, do you want KPB to provide you with a KPB-branded logo?(Required)

Yes

Acceptance of Community Responsibilities and Application Submission

Please initial below each requirement.

The Applicant understands the Certification Fee is non-refundable.(Required)

Initial here

The Applicant understands they are required to either use Keep Pennsylvania Beautiful’s branding and the name, “Keep xx Beautiful,” as the name of their affiliate program OR the affiliate will use our tagline below their existing logo.(Required)

Initial here

How did you hear about KPB affiliation?(Required)

X/ Twitter

Facebook

KPB Newsletter

KPB Press Release

KPB Affiliate

PennDOT

PA DEP

Municipality/County

Other

Other source(Required)

CAPTCHA