CTA's High Impact Tutoring (HIT) District Service Inquiry Primary Contact Information Question Title * 1. What is your first and last name? (Required.) Question Title * 2. What is your position or job title? (Required.) Question Title * 3. What is your phone number? (Required.) Question Title * 4. What is your email? (Required.) Question Title * 5. What is the best way to contact you? (Required.) Email Phone Question Title * 6. Would you be open to a brief introductory Zoom meeting? (Required.) Yes No Question Title * 7. Is there a secondary contact person? Yes No Question Title * 8. Secondary Person's Contract Information (Name, email, phone, etc) Basic Service Information Question Title * 9. What services are you requesting? (Required.) High Impact Tutoring Services Youth Programming Services Question Title * 10. What School District are you requesting services for? (Required.) Wayne County Public Schools (WCPS), Goldsboro NC Charlotte-Mecklenburg Schools (CMS), Charlotte NC Winston Salem-Forsyth Schools (WS/FCS) , Winston Salem NC Wake County Public Schools (WCP), Raleigh NC Greenville County Schools (GCS), Greenville SC Prince George's County Public Schools (PGCPS)- Community in Schools, MD Birmingham City Schools (BCS), Birmingham Alabama Plainfield Public Schools (PPS), Plainfield NJ Duval County Public Schools (DCPS), Jacksonville Fl Other Question Title * 11. If you selected 'other,' please share the respective school district and state? Question Title * 12. What service(s) are you requesting? (Required.) ELA (English Language Arts) Mathematics Science Other Question Title * 13. Do you have an anticipated start date for services, If so please provide the date? Date / Time Date Question Title * 14. What are your target grades? (Required.) Early Learning (K-2) Elementary (3-5) Middle (6-8) High School (9-12) Question Title * 15. Roughly how many students are you anticipating in need of assistance? (Required.) 10-50 51-100 Above 100 Submit