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Profile: Local Religious Institution Name of group ____________________________________________________________ Denominational affiliation __________________________________________________ Name of religious leader (pastor, rabbi, etc.) ____________________________________ Location ________________________________________________________________ Mailing address __________________________________________________________ Phone _______________________________ Fax ______________________________ E-mail __________________________________________________________________ Name & title of contact person________________________________________________ Home Phone __________________________ Work phone ________________________ Fax _______________________________ E-mail ______________________________ Structure ________________________________________________________________ Size ____________________________________________________________________ General Demographics (include number of youth by grade & gender) Target Market Racial & ethnic makeup Meeting days/times Special days/events 1A-12 |