Provider enrollment — HOPE For Everybody

Organization

Company or Organization Name *

Estimated number of clients served annually *

Used to highlight a suggested membership tier — you are not limited or restricted by your answer.

Total number of clients served (optional)

Type *

For Profit

Not for Profit

Non-Profit

Tax ID number *

Federal EIN or state Tax ID for your organization.

Contact

Contact name *

Contact title (optional)

Contact phone *

Contact email *

Founder name (if different than contact)

Address

Address *

Address 2 (optional)

City *

County *

State *

Limited to Texas at this time.

Zip *

Organization phone & email

Phone *

Email *

Screening

Are you willing to work with sex offenders? *

Yes

No

Links

Social media links (optional)

Website links *

Images

Profile pic / logo *

Header image (optional)

Needs & services

Specific needs your organization can meet

Suggested categories (optional)

List any categories you'd like added. Subject to admin approval before going live.

Description of your organization's products and/or services *

Brochure

Upload brochure / literature for your organization (optional)

Upload your current client list

Upload a list of current clients you'd like to use the HOPE For Everybody portal. Imported clients receive an email invitation to create their own login. Download the template to match your records to the expected format.

Client list file (optional)

Best format: a CSV with columns — First Name, Last Name, Email, Phone, County, Date of Birth, Notes.

Invite additional admins

Add junior or super admins for this provider account. Super admins may add/edit/delete admins, payment methods, or subscription level.

No additional admins added.

Providers

Create provider account