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

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

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

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

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

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

* 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? 

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

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

* 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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