<p> MUMFERD’S SAFETY TALES RESIDENCY APPLICATION APPLICANT INFORMATION Name of organization: Title/relationship to organization: Point of contact: Phone:</p><p>Organization address: City: State: ZIP Code: County: Number of classes: (if relevant) Age of children:</p><p>TELL US ABOUT YOUR CHILDREN: How would Mumferd’s Safety Tales be beneficial to the children at your facility?</p><p>Were you invited to apply for a Mumferd’s residency?</p><p>TELL US ABOUT YOUR GROUP: How long has your group been in existence?:</p><p>Mission of your organization: Are you a: (circle all relevant)</p><p>501c3 Non-profit organization </p><p>School daycare </p><p> headstart program </p><p> faith-based organization</p><p> program serving children with special needs: (please clarify:)______</p><p>Other:______</p><p>[ ] I verify all information is accurate to Print name: Date: the best of my knowledge Signature: Date:</p>