Organization Registration Form

FOCCUS, Inc USA

Organization Registration Form

Organization’s Name: ______

Address: City:

State:______Zip Code: ______

Phone #: Email Address:

Billing Address (if different from above):

Address: City:

State:______Zip Code: ______

Phone #:______Email Address:

Provide the name and email address of at least one trained FOCCUS Facilitator in your Organization. FOCCUS© requires that each church/organization have at least one trained facilitator registered. Certification numbers will be sent for the facilitator whose name is listed here. Email address must be different from Organization Administrator.

Facilitator Name: ______Email: ______

Please designatea FOCCUS “Organization Administrator” for your organization (the person who will manage any of the followingfunctions for your organization on the new FOCCUS website. Please do not list priest/pastor as the organization administrator):

Approve FOCCUS Facilitators
Create, Order and/or Transfer FOCCUS© Pre-Marriage Inventory Sessions
Generate, Print and/or Email FOCCUS© Couple Reports

Org Admin Name:______ Email: ______

Has this person been trained FOCCUS Facilitator? (this is not required) Yes No

Is this person already on the new FOCCUS, Inc. USA website? Yes No

Would you like your organization’s name, address and phone number listed on our website? Yes No

Willyour organization be functioning under a “Parent Organization”such as a diocese or central office? (e.g., to purchase or share inventory sessions or to score inventories) _X_ Yes If Yes, which organization? Diocese of Pueblo

______Diocese of Pueblo______101 N. Greenwood St., Pueblo, CO 81003______

Parent Organization Name Organization Address/City/State

Please SIGN this form and return it to FOCCUS usingone of these methods:

EMAIL: Save as an MS-WORD document (*.doc) and email to

FAX: To(402) 551-3050

MAIL: To FOCCUS, Inc. USA, Nazareth Hall, 3300 N. 60th St., Omaha, NE 68104

FOCCUS, INC. USA – ORGANIZATION AGREEMENT

Effective December 1, 2009

I agree to score the FOCCUS© Couple Report only for Certified FOCCUS Facilitators within my organization. I understand that the FOCCUS© Pre-Marriage Inventory is not used as a diagnostic or predictive instrument. I understand that the FOCCUS© Pre-Marriage Inventory is not a test; that one cannot fail it. I understand that the FOCCUS© Pre-Marriage Inventory is primarily intended to provide information to help couples discuss important topics prior to marriage. I understand that only the Certified Facilitator (not the couple or any other individuals) is to receive the FOCCUS© Couple Report and that it is to be destroyed after the facilitation process has ended. I agree not to copy or reproduce FOCCUS materials, including the inventory, manual or answer sheets, in any form, without express written permission of FOCCUS, Inc. USA.

I understand and agree that my organization will need to score Inventory Sessions using one of the two approved methods: 1) Online Entry (couple takes inventory online); 2) QuickScore (hard-copy answer sheets are entered online by Facilitator or FOCCUS Organization Administrator). I will make every effort to provide updated FOCCUS information about the FOCCUS website and scoring process to Facilitators in my organization who began using FOCCUS prior to December 2009. I understand that the best means of doing so would be for these individuals to attend official FOCCUS training by a Certified FOCCUS© Trainer or to attend online training on the FOCCUS website once such training is available, but that this is not required if my organization can provide this update itself. From this point forward, however, all new Facilitators within my organization will receive official FOCCUS Facilitator Training either online or by a Certified FOCCUS© Trainer. I understand that if we notice that any of our FOCCUS Facilitators are not listed within our online account, we will need to ask those Facilitators to register with FOCCUS, Inc. USA by creating an online FOCCUS account. Also, we will remove any facilitators from the online account who are no longer providing facilitation through our organization.

I understand I can address any questions to FOCCUS, Inc. USA by emailing or calling 402-827-3735 or 877-883-5422.

If my organization is functioning without a parent organization over it AND without any child organizations under it: I understand that all trained facilitators within my organization will need to register on the FOCCUS website at and that is it my responsibility to approve or deny requests by facilitators, to provide FOCCUS facilitation within my organization, and to do so in a timely manner. I understand that my organization may be eligible to have ‘child’ organizations under it. If my organization has such child organization(s) operating under it, I will have the ability to view, manage and transfer their FOCCUS© Pre-Marriage Inventory session credits and reports. I will respect the privacy of the couples and will treat all parties with the highest standards of ethics and integrity. If my organization is functioning under a parent organization (such as a diocese or national body), I understand that my parent organization has the ability to view, manage and transfer my organization’s FOCCUS© Pre-Marriage Inventory session credits and reports within the auspices of the parent organization, and I will respect the privacy of the couples and will treat all parties with the highest standards of ethics and integrity. If my organization is functioning as a parent organization with other organizations functioning under it (such as a parish, church, chapter or local branch), I understand that it is my responsibility to either approve or deny child organization requests in a timely manner. I understand that I have the option to extend any contract pricing discounts on products or inventory session credits agreed to by FOCCUS, Inc. USA to my child organization(s). I understand that I have the ability to view, manage and transfer FOCCUS© Pre-Marriage Inventory Sessions and FOCCUS© Couple Reports of my child organization(s). I will respect the privacy of the couples and will treat all parties with the highest standards of ethics and integrity.

Please sign in the box provided on the on previous page to indicate your agreement with this document. Thanks.

Please provide names of Trained FOCCUS Facilitators in your Organization

who are NOT already on the new FOCCUS website

FOCCUS is offering a one-time opportunity to grandfather your trained FOCCUS Facilitators.Please list below onlytrained FOCCUS Facilitators who use the FOCCUS© Pre-Marriage Inventory and are not already registered on our website. Your list must be returned to FOCCUS, Inc. USA by 03/15/13, After this deadline, all other individuals in your organization who wish to use the FOCCUS© Pre-Marriage Inventory may be required to take a refresher training by a certified FOCCUS Trainer or the FOCCUS© online training.

You will be sent certification numbers and instructions allowing these individuals you list below to register on the website as FOCCUS Facilitators. By returning this form, you are verifying that these individuals have been properly trained to interpret and facilitate the FOCCUS© Pre-Marriage Inventory and that they have agreed to the Facilitator terms on the next page.

Name / Email address / Phone / Approx. date trained as a FOCCUS Facilitator / Trained by whom?

I hereby verify that these individuals are trained and active FOCCUS Facilitators and that I will make them aware of the FOCCUS Facilitator Attestation terms on the reverse side of this page.

Name: ______Title: ______

Organization ______

Please return this form to FOCCUS, Inc. USA

(presented here for your reference only)

*NOTE: All FOCCUS Facilitators are required to agree to these terms when registering on the FOCCUS website. If they are not in agreement please do not list their names for grandfathering and do not allow them to use the FOCCUS© Pre-Marriage Inventory.

I agree to explain to couples that the FOCCUS ©Pre-Marriage Inventory is intended to provide information to help couples discuss topics

I recognize that discussion and/or time often changes the way a couple would respond to inventory items

I agree to meet with couples at least twice following receipt of the FOCCUS© Couple report, to discuss the results and encourage further communication.

I agree to offer additional resources to couples who appear to be in distress

I agree to destroy the couples’ FOCCUS© Couple Report after the last facilitation session and not give a copy to the couple to keep.

I agree not to copy or reproduce any FOCCUS materials, including the inventory or answer sheets, in any form, without express written permission of FOCCUS, Inc. USA.

I understand that I can address any questions to FOCCUS Inc. USA by emailing or calling (402) 827-3735 or 877-883-5422.