All agencies / organizations / groups offering to partner with Communities in Schools (CIS) must complete a Partnership Registration Form. This ensures that the partnership relationship is clearly aligned with mission and goals of CIS and the enrolled students / families served. Partnership Registration will also assist CIS in properly acknowledging the work and resources provided to CIS students and families annually by the partner agency / group or organization. Name of Agency / Organization / Group*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Contact Person*Phone*Email* Service(s) proposed by partner group*Please describe below the services proposed to be delivered to students and/or family at the school, the frequency and duration.Is there an evidence-based curriculum that will be utilized? If yes, please name.How will your services impact academic achievement for students?*School / grade level proposed for these services:*Questions? Contact Andrew Ladd, VP of Planning and Agency Partnerships. aladd@cischarlotte.org | 704.943.9436
