What is the official corporate name and address of your organization?

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* 1. What is the official corporate name and address of your organization?

Please indicate your organization's tax status? 

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* 2. Please indicate your organization's tax status? 

Please select the zip codes you will be serving.

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* 3. Please select the zip codes you will be serving.

Please describe how your organization currently serves children age 0-5?

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* 4. Please describe how your organization currently serves children age 0-5?

Do you plan to partner with other organizations for family recruitment work, book inventory loss prevention and redistribution? 

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* 5. Do you plan to partner with other organizations for family recruitment work, book inventory loss prevention and redistribution? 

Are you already involved with other evidence-based or evidence-informed pre-literacy programs and/or initiatives for children age 0-5? 

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* 6. Are you already involved with other evidence-based or evidence-informed pre-literacy programs and/or initiatives for children age 0-5? 

NCPC, Inc. will develop information about DPIL and a link for parents to register online as well as promote registration through a variety of outlets. Are you able to promote this centralized registration through your website, social media, and other promotional opportunities? 

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* 7. NCPC, Inc. will develop information about DPIL and a link for parents to register online as well as promote registration through a variety of outlets. Are you able to promote this centralized registration through your website, social media, and other promotional opportunities? 

Please describe your plan for program sustainability after June 2019?

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* 8. Please describe your plan for program sustainability after June 2019?

Do you agree to participate in NCPC's State evaluation including NCPC's March 2018 report to the NC General Assembly?

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* 9. Do you agree to participate in NCPC's State evaluation including NCPC's March 2018 report to the NC General Assembly?

Whom on your staff should we contact if we want to talk with you about how the Imagination Library is going?

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* 10. Whom on your staff should we contact if we want to talk with you about how the Imagination Library is going?

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