Become a CHAMPION of American
Graduate

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* 1. Required Contact Information:

First Name:

Last Name:

City/Town:

State:

ZIP Code:

Email Address:

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* 2. Optional Contact Information:

Street Address:

Street Address 2:

Phone Number:

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* 3. What is your local public media station?

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* 4. Which American Graduate Day partner organization(s) are you interested in connecting with? Check all that apply.

52nd St Project

After-School All-Stars

America SCORES

America's Promise Alliance

Big Brothers Big Sisters of America

Boys and Girls Clubs of America

build On

CFY

Change for Kids

Children's Aid Society

City Year

Civic Enterprises

Communities in Schools

Counseling in Schools

Girls Inc

Good Shepherd Services

Harlem RBI

Horizons National

Jumpstart

Little Kids Rock

NAACP

National Council of La Raza

NYC Mayor's Task Force on Truancy, Chronic Absenteeism and School Engagement

PAL NYC

Partnership with Children

Reel Works

Rise Up and Walk

United Way

YMCA

Young Audiences NY

YouthBuild

Other (please specify)

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* 5. Which of the following are you most interested in? Check all that apply.

Volunteering (e.g. mentoring, tutoring)

Getting more information (e.g. newsletter, email list)

Providing In-Kind Services (e.g. donate school supplies, musical instruments)

Other (please specify)

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* 6. Were you aware of the dropout crisis in America before watching or listening to American Graduate Day?

Yes

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* 7. Do you better understand how you can help as a result of the American Graduate Day program?

Yes

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* 8. What in the American Graduate Day program inspired you to become an American Graduate Champion?

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* 9. Please share any additional comments or feedback:

*Please note: your submission of this information indicates approval to be contacted by American Graduate, your local public broadcasting station and/or partner organization(s).