Program Information

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1. What is the name of your program (as you would like it displayed)?

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2. What is your name and role in the program?

Please also provide an email address or phone number at which to contact you.

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3. From what date to what date does your program operate? How many days a week and for how long each day?

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4. Where does your program take place? What is the address?

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5. How many students do you serve? What are their ages?

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6. In what neighborhoods, school districts, towns, or areas do your students live?

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7. Who are your partners?

List organizations you work with – other non-profits, school district, funders, sources of volunteers, etc.

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