National Charter Collaborative Membership Request

Tell Us A Little About You

Question Title

* 1. Your Personal and Contact Information

First Name

Last Name

Work Email Address

Executive Assistant Email Address

Cell Phone Number

Enter your date of birth (MM/DD/YYYY):

Question Title

* 2. Tell us a little about yourself. Include your professional background and current position.

Question Title

* 3. Please upload a professional headshot.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

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

Black

Latino

Asian

Native American

Middle Eastern/North African

Pacific Islander

Caucasian

Other (please specify)

Question Title

* 5. Your title at your school

Question Title

* 6. Are you the founder?

Yes

Question Title

* 7. Are you currently a leader of a single-site charter school or small network of 3-5 schools?

Yes, I'm a leader of a single-site charter school

Yes, I'm the leader of a small network of 3-5 charter schools

Question Title

* 1. Your Personal and Contact Information

Question Title

* 2. Tell us a little about yourself. Include your professional background and current position.

Question Title

* 3. Please upload a professional headshot.

Question Title

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

Question Title

* 5. Your title at your school

Question Title

* 6. Are you the founder?

Question Title

* 7. Are you currently a leader of a single-site charter school or small network of 3-5 schools?

Question Title

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