Indiana Afterschool Network

Indiana Out-of-School Time Pledge to Quality Interest Form

Thank you for your interest in the Indiana Out-of-School Time Pledge to Quality. By completing this form the Indiana Afterschool Network will have a better understanding of how to help you increase program impact in your community.

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* 1. Your Name

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* 2. Your Organization Name

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* 3. How many program sites does your organization serve?

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* 4. Your Program Site Name

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* 5. Are you a current 21st Century Community Learning Center Program?

Yes

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* 6. I am interested in signing up for the IN Afterschool e-news

Yes

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* 7. I am interested in registering my program(s) in the Indiana Program Mapping Database

Yes

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* 8. I am interested in aligning with the Indiana Afterschool Standards

Yes

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* 9. I am interested in aligning with the Indiana Afterschool Specialty Standards (check all that apply):

STEM

College and Career Readiness

Summer Learning

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* 10. I am interested in learning more about the Indiana Quality Program Self-Assessment (IN-QPSA)

Yes

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* 11. Your Contact Information

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 12. What is your preferred method of communication?

Phone

Either

The Indiana Afterschool Network is excited about your Pledge to Quality and will reach out to you soon.