The purpose of this form is to collect information from new partners and update information for committed partners within the Keystone Kids Go workgroup.  Please review the following information prior to signing this form.

1. Review the Keystone Kids Go Orientation materials, which can be found on the Keystone Kids Go member page of the website. To access the member page, visit www.keystonekidsgo.org. Scroll to the bottom of the Home page and click "KKG Member Page." When prompted, enter the password, kkgmember2020.
2. Review the information and commitments within this form. 
3. Complete this sign-on as a committed KKG Workgroup partner!
Please email questions and comments to lmcmonigal@tiu11.org

Question Title

* 1. Date

Date

Question Title

* 2. Name

Question Title

* 3. Email address

Question Title

* 4. Phone Number

Question Title

* 5. Which sector do you represent? Please check all that apply

Question Title

* 6. Are you participating in KKG as a representative of an organization/agency?

Question Title

* 7. If yes, name of organization/agency

Question Title

* 8. If yes, your role/job title:

Question Title

* 9. Participating members are listed on the KKG website.  Would you like to provide a high-resolution of an organization/agency logo for the KKG website?

Question Title

* 10. Please briefly describe your/your organization's connection to Pennsylvania Early Care and Education and/or Health sectors:

Question Title

* 11. Please indicate your commitment to the following terms of workgroup membership. Please refer to the Membership Letter (mentioned at the top of this form and accessible from the Keystone Kids Go member page) to review the workgroup's structure and membership responsibilities.

  • Attendance (virtually) at meetings from 1-3 PM the third Monday every two months (July, November, January, March, May). 
  • Contribute ideas to the areas of focus and assist in action step implementation when applicable
  • Become familiar with KKG website (particularly the coaching resources) and contribute feedback on new and existing resources
  • Participate in small workgroups focused on equity, annual meeting planning, and/or a steering committee (optional opportunities) 

T