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 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

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