Membership Submitted

Statistical information is very valuable to Abilities Manitoba. Please select one:

I will download the form and submit it within 6 weeksI'd like to schedule a phone call to provide this informationI'd like to complete this info online now

 

Please Download the Following Document:
Download Member Stats Form

 

Please Complete the Following
Fields marked with "*" are required.

 

Agency Name *
Contact Name *
Phone Number *

 

Please let us know the best time to call:

 

 

Please Complete the Following
Fields marked with "*" are required.

 

Agency Name *

 

Select the regions you deliver services in:
CentralEastmanInterlakeNorthernParklandsWinnipegWestman

 

Do you provide support to populations other than adults with intellectual disabilities?
YesNo

 

Total Number of Employees *
Number of Direct Support Positions *
Number of Unionized Employees *
Number of Non-Unionized Employees *
Union Involved
Year Organization Was Unionized

 

How many people do you support in each service type? (enter 0 if not applicable)

Day Services *
Employment *
Social Enterprise *
Supported Independent Living *
Residential Services *
Home Share (formerly Foster Care) *
Respite *
Crisis Support *
Other

 

Number of volunteers who contribute to the work of your agency (include volunteer Board of Directors) *

 

Number of people you support who volunteer during hours you provide services to them *

 

 

Board President *

Name
Email Address

We aim to contact Board Presidents 1-2 times per year to provide a newsletter.

 

Finance/Accounts Receivable

Complete this if you want invoices forwarded to someone other than the Executive Director.

Name
Email Address

 

Who would you like to receive Abilities Manitoba emails aside from the Executive Director?

Name
Title
Email

 

Name
Title
Email

 

Name
Title
Email

 

Name
Title
Email