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Provider Application

R.A.R.E. Suppport Network Transbackground logo

Please provided the Providers contact information in this section, your company and public information will be collected next. 

Provider Mobile Number
Provider Office Phone Number

Company Public Information

Phone customers call
Company Street address
Company City
Company State
Please provide the County your business operates

Credentials

What licenses, certifications, or qualifications are required to the services you provide?
(List all credentials necessary to offer the service(s).)
List all credentials required to provide service. If your service does not require credentials write N/A
Are your credentials currently in good standing with the issuing authority?*
How are services be provided?*
Type of Service Provider*
Select all that apply

Social Media

Let's connect on social media!  Increase your social media following by connecting with us!

Provider Attestation

By submitting this application, I:

  • Attest that all information provided in this application is accurate and true to the best of my knowledge.
  • Commit to providing services ethically and maintaining good standing with any relevant licensing or credentialing authorities.
  • Understand that completing this application does not provide referrals; rather, it ensures that providers meet our standards before participating in the network. Approval provides access to the private social media group we are launching, where you can post and interact with other members, but does not provide direct referrals.

    Membership in the R.A.R.E. Support Network is free and does not guarantee funding from Working with Hope, Inc which is separate organization.

    Grant Funding Purpose – If you apply for and are awarded a grant, those funds are to be used to provide services to qualified individuals you identify who meet the grant criteria. These individuals must be “referred” to the R.A.R.E. Support Network for grant reporting purposes only. This process ensures that those in need of care can access services at no cost or a reduced rate, covered by the grant funds, while also allowing us to track impact and apply for additional funding from supporting organizations in the future.