21st Century Community Learning Centers
External Providers for Out-of-School Time Programming

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* Provider Overview

Entity Name

Non-Profit or For-Profit

Website

Demo URL (if available)

Effectiveness Data URL (if available)

Years in Operation

Do you offer a performance guarantee? (Yes/No)

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* Type of Provider

School District

Board of Cooperative Education Services (BOCES)

Charter School

Community Agency

Institution of High Education

Faith-Based Organization

For-Profit Company

Individual

Other (please specify)

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* Level of Services Provided (select all that apply)

Elementary

Middle School

High School

Afterschool/Before School

Summer

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* Type of Services Provided (select all that apply)

Bullying Prevention

Dropout Prevention and Intervention

Essential Skills/21st Century Skills

Health and Wellness

Parent/Family Engagement

Professional Development

Program Evaluation

Technology

Other (please specify)

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* Provider Qualifications

Entity Qualifications (licensure, trademarks, etc.)

Instructor/Staff Qualifications

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* Primary Contact for Provider

First and Last Name

Mailing Address

Phone

E-mail

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* Secondary Contact for Provider (if applicable)

First and Last Name

Mailing Address

Phone

E-mail

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* Name of Schools/Districts your organization has served in Colorado (if applicable) and contact name with phone number or e-mail address:

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* Name of Schools/Districts your organization has served outside of Colorado (if applicable) and contact name with phone number or e-mail address:

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* Detail the cost of services available for educational services you provide.

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* Explain how you are able to provide differentiated services to meet the individual needs of schools and districts.

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* How will you evaluate your services and support to schools and districts and its effectiveness in student achievement?

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* Provide a sample of services offered for a school or district under 500 students:

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* Provide a sample of services offered for a school or district from 500-1000 students:

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* Provide a sample of services offered for a school or district with 1000+ students:

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* Recent References: Please provide names and contact information for at least two organizations which have used your services in the last 12 months.
(Please note: CDE personnel may not be listed as references.)

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* Provider Overview

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* Type of Provider

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* Level of Services Provided (select all that apply)

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* Type of Services Provided (select all that apply)

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* Provider Qualifications

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* Primary Contact for Provider

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* Secondary Contact for Provider (if applicable)

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* Name of Schools/Districts your organization has served in Colorado (if applicable) and contact name with phone number or e-mail address:

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* Name of Schools/Districts your organization has served outside of Colorado (if applicable) and contact name with phone number or e-mail address:

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* Detail the cost of services available for educational services you provide.

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* Explain how you are able to provide differentiated services to meet the individual needs of schools and districts.

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* How will you evaluate your services and support to schools and districts and its effectiveness in student achievement?

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* Provide a sample of services offered for a school or district under 500 students:

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* Provide a sample of services offered for a school or district from 500-1000 students:

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* Provide a sample of services offered for a school or district with 1000+ students:

Question Title

* Recent References: Please provide names and contact information for at least two organizations which have used your services in the last 12 months.(Please note: CDE personnel may not be listed as references.)

* Recent References: Please provide names and contact information for at least two organizations which have used your services in the last 12 months.
(Please note: CDE personnel may not be listed as references.)