Form Submission for the

Pride Rocks! Resource Card

ABOUT PRIDE ROCKS!

The Pride Rocks! Resource Card

NCCJ will print and distribute 2,500 resource cards with LGBTQ+ community resources. These cards are distributed throughout the Dayton community. Complete the below form to be featured on the card.

Please Note: After registration, NCCJ will contact your business to confirm your information and ask questions about your inclusive practices. Completion of this form does not guarantee your inclusion on the card.

Timeline:

March 18, 2024: Applications for the Resource Card are due

Prior to April 1, 2024: NCCJ will call your organization to confirm information. If you do not pick up the call, please call us back by April 5. (NCCJ will likely call your business within 1-3 days of you completing this application)

May 18, 2024: The resource cards are brought to Pride Rocks! and distribution begins

Thank you for all you do for the community!

Please Note:

NCCJ publishes this resource card on half page rack cards. Due to the limited space on these cards, every submission may not be included on the print version. NCCJ will give priority to those providing mental health treatment services, and then will fill in spaces. Services that are not included on the printed cards may be included on the website version.


Pride Rocks! Resource Card Registration

2024 LGBTQ+ Provider List

This information will be published exactly as it written in this box
Organization Contact Person Name(Required)
This person will be called prior to the printing of the resource list to verify the accuracy of the information and to ask questions regarding the organizations efforts to be inclusive. This will NOT be published.
Contact Person Email(Required)
This information will NOT be published and is provided in the case that NCCJ needs to contact you regarding this listing.
This information will NOT be published and is provided for NCCJ to contact you prior to publishing the listing.
Organization Address(Required)
This information will be published
This information will be published
This information will be published as it is written. If your organization has several separate services (for example a housing program, and a mental heath program), please fill out a form entry for each distinct service.
Entry to this form is FREE, however donations allow us to print additional resources and share this information further.(Required)
Selecting "Free Entry" below has no impact on the order your organization will appear on this document or the approval of your application. Donations below are to support the distribution of resource cards and will not effect your organizations entry.
This field is for validation purposes and should be left unchanged.