TxCAN Membership Form
Local College Access Network (LCAN) / Non- Profit Organization / College Access Program or Provider/ Foundation

We are so glad you are here! Please tell us a little about yourself.

Question Title

* 1. How would describe yourself?

I am representing a Local College Access Network (LCAN).

I am representing a Non-Profit Organization

I am representing a College Access Program or Provider

I am representing a Foundation.

Other (please specify)

Question Title

* 2. Please tell us a little about yourself.

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 3. Please provide your organizations contact information.

Department (if applicable)

College / Business / School / School District

Mailing Address

Mailing Address 2

City/Town

State/Province

ZIP/Postal Code

Question Title

* 4. If your organization or program exists within a larger organization, please tell us which type of organization. Please select all that apply.

United Way

Chamber of Commerce

Foundation

School District

College or University

Larger Non-Profit

Public Agency

N/A

Other (please specify)

Question Title

* 5. As we collect data on membership an important questions roughly how many students does your organization serve?

1-500

500-1,000

1,000-3,000

3,000-5,000

5,000-8,000

8,000-10,000

10,000-20,000

20,000 +

N/A

Other (please specify)

Question Title

* 6. Which ESC Region(s) do you serve? Please select all that apply.

Region 1 - Edinburg

Region 2 – Corpus Christi

Region 3 – Victoria

Region 4 – Houston

Region 5 – Beaumont

Region 6 – Huntsville

Region 7 – Kilgore

Region 8 – Mount Pleasant

Region 9 – Wichita Falls

Region 10 – Richardson

Region 11 – Fort Worth

Region 12 – Waco

Region 13 – Austin

Region 14 – Abilene

Region 15 – San Angelo

Region 16 – Amarillo

Region 17 – Lubbock

Region 18 – Midland

Region 19 – El Paso

Region 20 – San Antonio

We do not operate in Texas

Question Title

* 7. What types of partners does your LCAN convene? Please select all that apply.

Schools & School Districts

College Access Providers

Colleges & Post Secondary Programs

Corporate

Foundations

Workforce

Other (please specify)

Question Title

* 8. What are the top social issue (s) addressed by your NON-PROFIT organization? Please select all that apply.

Education

Health

Economic Security

Environmental Protection

Other (please specify)

Question Title

* 9. How would you like to get involved with TxCAN? Please select all that apply.

Volunteer with TxCAN or Partner Organizations

Attend Events

Provide staff volunteers for TxCAN or other College Access Partners

Co-Sponsor events or special initiatives

Attend events to learn more about college access

Receive feedback and support on your college access
initiatives

Participate in convening and professional development
opportunities.

Other (please specify)

Question Title

* 10. Why does your NON-PROFIT organization want to connect to TxCAN? Please select all that apply.

The youth we serve need access to college and other post-secondary opportunities.

We would like to add college access to our work.

We want to learn about college access issues.

We believe college access issues are important and we want to show our support for your work.

Other (please specify)

Question Title

* 11. We will include logos in some of our promotional materials. If you would like us to consider using your logo, please upload a hi-res image file.

GIF, JPEG, JPG, PNG file types only.

Choose File

Question Title

* 12. If you would like us to include other staff members on our mailing list, please type their names and email addresses below.

They can also individually use the newsletter signup form on our website.

Question Title

* 1. How would describe yourself?

Question Title

* 2. Please tell us a little about yourself.

Question Title

* 3. Please provide your organizations contact information.

Question Title

* 4. If your organization or program exists within a larger organization, please tell us which type of organization. Please select all that apply.

Question Title

* 5. As we collect data on membership an important questions roughly how many students does your organization serve?

Question Title

* 6. Which ESC Region(s) do you serve? Please select all that apply.

Question Title

* 7. What types of partners does your LCAN convene? Please select all that apply.

Question Title

* 8. What are the top social issue (s) addressed by your NON-PROFIT organization? Please select all that apply.

Question Title

* 9. How would you like to get involved with TxCAN? Please select all that apply.

Question Title

* 10. Why does your NON-PROFIT organization want to connect to TxCAN? Please select all that apply.

Question Title

* 11. We will include logos in some of our promotional materials. If you would like us to consider using your logo, please upload a hi-res image file.

Question Title

* 12. If you would like us to include other staff members on our mailing list, please type their names and email addresses below. They can also individually use the newsletter signup form on our website.

* 12. If you would like us to include other staff members on our mailing list, please type their names and email addresses below.

They can also individually use the newsletter signup form on our website.