National Charter Collaborative Membership Request

Tell Us A Little About You

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* 1. Your Contact Information

First Name

Last Name

Work Email Address

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* 2. What racial group do you primarily identify as?

Black

Latino

Asian

Native American

Middle Eastern/North African

Pacific Islander

Caucasian

Other (please specify)

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* 3. Your title at your school

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* 4. Are you the founder?

Yes

No

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* 5. How many years have you been at your school?