2025 Prevention Council Re-Chartering Agreement "*" indicates required fields This document establishes the agreement between Prevent Child Abuse Indiana, a Division of The Villages, (heretofore referred to as "PCAIN") and (type Your Council's Name)Name of Council*(heretofore referred to as "PCAIN Chartered Council") for the period of January 1st to December 31st. The Agreement The agreement between PCAIN and all PCAIN Chartered Councils is based on the mutual understanding that we will continually work together to build a statewide organization and network that enables all sectors of the community to play a significant role in preventing child abuse and neglect. Mutuality of Agreement In affirmation of our agreement, both PCAIN and the PCAIN Chartered Council will support and promote one another to the greatest extent possible. It is respectfully understood that each of our activities in some way reflects on Prevent Child Abuse America (PCAA) as well as our state and local images. Each entity must take great care to ensure that our actions correspond with the vision, core values, guiding principles and position statements established by PCAA. PCAIN Responsibilities PCAIN has a commitment to provide technical assistance to Chartered Councils, resources permitting. Chartered Councils will receive all established benefits, outlined in Appendix A. Council Responsibilities Chartered Councils are expected to maintain compliance with the criteria for PCAIN Chartered Councils throughout the charter period (Appendix B). Should there be any major change in a Council’s organization or in its ability to be in compliance with the criteria, the Council agrees to notify PCAIN in writing within sixty (60) calendar days. The Charter This charter acknowledges that the PCAIN Chartered Council is in compliance with the criteria of PCAIN and is granted annually. When a charter is granted, the PCAIN Chartered Council will pay a yearly Chartering Fee. Chartering fees are not refundable. Appendices The Appendices (A through H) are considered an integral part of this Chartering Agreement and can be accessed on the PCAIN Council Portal at www.pcain.org under Council Documents. Certification As an authorized officer ofAuthorized Officer*Agreement* I agree that our Council's Officers will review the Appendices yearly.*I hereby certify that our organization is applying to be a Chartered Prevention Council of Prevent Child Abuse Indiana. I further certify that we understand this agreement (including all Appendices) and that we will maintain compliance with it.Your Name* First Last Person filling out the Chartering AgreementCounty / Counties Served*Primary Contact InformationThis information will appear on the Prevent Child Abuse Indiana website so that people can contact your Council. It is important that the contact person is available to receive information. We will also use this information to send postal mail.Responsibilities of the Primary Contact Person are:Be available to the PCAIN Staff through email and phoneAct as the messenger to the rest of your Council’s Officers and VolunteersNotify PCAIN Staff of any Officer or Contact changesPrimary Contact Person*Your Email* Preferred Phone*Preferred Phone Type* Home Work Cell Alternate PhoneAlternate Phone Type Home Work Cell Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Shipping Address (no P.O. Box) Same as Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Description of Council Activities (to be used on PCAIN website on your council page)*Does your Council operate under the umbrella of another organization and use their 501c3?* Yes No Name of that OrganizationFederal Tax Exempt #When do you usually hold your meetings?*Day of the Week*MondayTuesdayWednesdayThursdayFridaySaturdaySundayWeek of the Month*FirstSecondThirdFourthTime* Hours : Minutes AM PM AM/PM Anticipated needs for the coming year* Strategic Planning Volunteer Recruitment Board Orientation No needs at this time Other Other Needs*Would you like your Chartering Certificate...* Emailed to Me - I print Printed copy mailed to me Is your Council interested in receiving your rechartering and/or April - Quick Cards for 2025? Yes No When chartering you are eligible to receive up to 800 free Quick Cards (16 Packages of 50 Cards per Package). For April you can receive up to 200 free Quick Cards (4 Packages). If you choose YES, you will be emailed the order form.PCAIN Quick Cards are currently in English and Spanish. Is there a need in your area for other translations? Please list:*Board OfficersRemember, if you change Officers or the Main Contact throughout the year to notify PCAIN by using the "Change of Officers" form ASAP. That form is located on the PCAIN website, on the Council Documents Page.PresidentPresident Name* First Last President Term Ends Month Day Year President's Email* President's Preferred Phone*Preferred Phone Type* Home Work Cell President's Alternate PhoneAlternate Phone Type Home Work Cell Vice PresidentVice President Name* First Last Vice President Term Ends Month Day Year Vice President's Email* Vice President's Preferred Phone*Preferred Phone Type* Home Work Cell SecretarySecretary Name* First Last Secretary Term Ends Month Day Year Secretary's Email* Secretary's Preferred Phone*Preferred Phone Type* Home Work Cell TreasurerTreasurer Name* First Last Treasurer Term Ends Month Day Year Treasurer's Email* Treasurer's Preferred Phone*Preferred Phone Type* Home Work Cell Please notify PCAIN of any Officer Changes throughout the year Council Members / Council Volunteers Please provide the names and contact information for other members/volunteers of your Council who do not serve as officers. We use this list when sending out the Council Courier Enewsletter every other month. Our lists are not shared with other persons/organizations outside of PCAIN. You may also email your member/volunteer list to the PCAIN Administrative Assistant or PCAIN Director jwittman.pcain@villages.org (Excel Spreadsheet preferred).Please fill out (emails will only be used to send out the bi-monthly Council Courier Newsletter)*NameEmail Add RemovePinwheel Ordering/Shipping InformationBeginning in 2025, PCAIN will no longer provide boxes of pinwheels to their councils. If you still need or want physical pinwheels, please contact the PCAIN office for the national order information.Payment ChoicesHow will you pay?*Credit Card (via Square)Check (to be sent ASAP to the PCAIN Office)Credit Card* Cardholder Name Card Details 2025 Chartering Fee* Price: If you complete this Charter after December 31st at 3:00 PM the fee increases to $250.00Total 2025 Chartering fee When paying by check, be sure to add the chartering fee of $200.00< CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
