Survey & Form Center

Please note there is no log-in required to submit this or any other form in the Form Center.
Please make sure to save progress if you are not finished with the form and are exiting the page.
By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

2023 Program Directory - Violence Prevention

  1. JacksonCountyCOMBATAllHandsIn
  2. Important

    To submit this form you do not have to sign in or create a Form Center account (above. However, you will have to complete the form in its entirety without the option to save your progress unless you do create an account.

  3. General Information
  4. Use "N/A" if agency doesn't have a website.

  5. Area(s) Of Focus*
  6. Program Descriptions
  7. Third-Person

    These summaries will be appearing on Therefore, it is important that they be written in third person, using the program's and agency's name. Summaries written in the first person ("we," "our," etec.) can lead to confusion in that visitors to the site might believe that COMBAT is directly operating your program.

  8. This is brief summary of your program (limit 1,000 characters) is for use on our website index pages, where space is limited.

  9. There is no character limit for the detailed description you can provide here. You can likely take the description from your fundng application, though be sure to edit accordingly to eliminate any first-person references.

  10. Program Contact Information & Locations

    This information will be published on the COMBAT website.

  11. Include the name of school, church, community center, etc. Also list specific phone for that location if different than the contact number provided above.


    Irving Elementary School

    505 N. Elm Street, Kansas City, MO 64106


  12. Other Contacts

    This information will not be published on our website, but email addresses will be added to our providers list for communications from COMBAT.

  13. Director, Executive Director, President, etc.

  14. Signature
  15. By typing your name in the "Signature" box below, you acknowledge that this "electronic signature" is valid to the same effect of a traditional handwritten signature.

  16. Leave This Blank:

  17. This field is not part of the form submission.