National Charter Collaborative Membership Request

Tell Us A Little About You

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* 1. Your Personal and Contact Information

First Name

Last Name

Work Email Address

Executive Assistant Email Address

Cell Phone Number

Enter your date of birth (MM/DD/YYYY):

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* 2. Have you completed a survey with us?

Yes

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* 3. Tell us a little about yourself. Include your professional background and current position.

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* 4. Please upload a professional headshot.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 5. What racial group do you primarily identify as?

Black

Latino

Asian

Native American

Middle Eastern/North African

Pacific Islander

Caucasian

Other (please specify)

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* 6. What is your current title or role in your field?

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* 7. If you are a school leader, are you the founder?

Yes

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* 8. Are you currently a leader of a single-site charter school or small network of 3-5 schools?

Yes, I'm a leader of a single-site charter school

Yes, I'm the leader of a small network of 3-5 charter schools

Question Title

* 1. Your Personal and Contact Information

Question Title

* 2. Have you completed a survey with us?

Question Title

* 3. Tell us a little about yourself. Include your professional background and current position.

Question Title

* 4. Please upload a professional headshot.

Question Title

* 5. What racial group do you primarily identify as?

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* 6. What is your current title or role in your field?

Question Title

* 7. If you are a school leader, are you the founder?

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* 8. Are you currently a leader of a single-site charter school or small network of 3-5 schools?

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* 9. If you are a school leader, how many years have you been at your school?