Add Your Program

First Name *

Last Name *

Position Title *

Email Address *

Name of Organization *

Description of Organization *

Name of Executive Director *

Organization Street Address *

Organization Phone Number *

Name Of Program *

Organization / Program Website *

Description of Program *

Program Site Address *

Program Site Phone Number *

Name Of Individual Completing This Form *

Title Of Individual Completing This Form *

Direct Telephone Number Of Individual Completing This Form *

Email Address Of Individual Completing This Form *

Overview of Organization (up to 3 sentences) *

Overview of Program (up to 3 sentences) *

Email Address Of Individual Completing This Form *

Date of Program Start *

Date of Program Finish *

Days Program Is Offered (list them out) *

Time of Program *

Name of Contact for Student Enrollment *

Title of Contact for Student Enrollment *

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If you provide meals, how do you cover the cost *

Government FundingPrivate FundingOther

Enrollment Start Date *

Enrollment End Date *

Average Financial Aid Awarded *

Enrollment Requirements *

Describe any accommodation for individuals with disabilities on site *

Maximum Enrollment *

Average Financial Aid Awarded *

Is Transportation Provided To Your Program? *

YesNo

Tuition fees charged *

Total program days of operation *

Total program hours of operation *

Primary focus of program *(Ex. STEM, Personal Enrichment, Health and Wellness, etc)

Does the program employ at least one certified teacher? *

YesNo

What is the youth outcome goal for the program? *

Does your program have any quality improvement goals? *

Add Your Program

INCREASING PROGRAM CAPACITY

Location Type *

Meals Offered *

If you provide meals, how do you cover the cost *

Grades Served *

Enrollment Type *

Is Transportation Provided To Your Program? *

Does the program employ at least one certified teacher? *